MEDICARE: MICHIGAN INSTITUTE OF NEUROLOGICAL DISEASES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	4301072378	MI

General Provider Information

NPI Number	:	1356668610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN INSTITUTE OF NEUROLOGICAL DISEASES, PLLC

Provider Business Mailing Address
First Line	:	5091 OAK TREE CT
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-8573
Country	:	US
Telephone Number	:	517-795-1416
Fax Number	:	517-787-4280

Provider Business Practice Location Address
First Line	:	205 PAGE AVE
Second Line	:	SUITE B
City	:	JACKSON
State	:	MI
Zip	:	49201-2462
Country	:	US
Telephone Number	:	517-795-1416
Fax Number	:	517-787-4280

Authorized Official
Title or Position	:	OWNER/MEDICAL PHYSICIAN
Name	:	DR. UMESH VERMA
Credential	:	M.D.
Telephone Number	:	517-990-5331

Provider Enumeration Date	:	04/27/2010
Last Update Date	:	07/23/2010

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