MEDICARE: TRICOUNTY NEUROLOGICAL 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	2084N0400X	Neurology Physician	5101006993	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	130E06358	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1588753958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRICOUNTY NEUROLOGICAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	39581 GARFIELD RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-4300
Country	:	US
Telephone Number	:	586-286-2770
Fax Number	:	586-286-9080

Provider Business Practice Location Address
First Line	:	39581 GARFIELD RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-4300
Country	:	US
Telephone Number	:	586-286-2770
Fax Number	:	586-286-9080

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAY JOSEPH KANER
Credential	:	DO
Telephone Number	:	586-286-2770

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	06/08/2015

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