MEDICARE: MICHIGAN NEUROLOGY ASSOCIATES, P.C.

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	261QA1903X	Ambulatory Surgical Clinic/Center	1010000026	MI

General Provider Information

NPI Number	:	1518247295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN NEUROLOGY ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	34025 HARPER AVE
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48035-3737
Country	:	US
Telephone Number	:	586-445-9900
Fax Number	:

Provider Business Practice Location Address
First Line	:	34025 HARPER AVE
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48035-3737
Country	:	US
Telephone Number	:	586-445-9900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS GIANCARLO
Credential	:	M.D.
Telephone Number	:	586-445-9900

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	01/18/2022

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