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NPI Code Detail

MEDICARE: NEUROGLIA PLLC

MEDICARE: NEUROGLIA 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
1103G00000XClinical Neuropsychologist

General Provider Information

NPI Number : 1952949380
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEUROGLIA PLLC
Provider Business Mailing Address
First Line : 1525 S HIGLEY RD STE 104
Second Line :
City : GILBERT
State : AZ
Zip : 85296-5045
Country : US
Telephone Number : 847-913-4154
Fax Number : 480-535-5858
Provider Business Practice Location Address
First Line : 1525 S HIGLEY RD STE 104
Second Line :
City : GILBERT
State : AZ
Zip : 85296-5045
Country : US
Telephone Number : 847-913-4154
Fax Number : 480-535-5858
Authorized Official
Title or Position : OWNER
Name : DR. SURABHI YESHWANT PATWARDHAN
Credential : PH.D.
Telephone Number : 847-913-4154
Provider Enumeration Date : 12/16/2019
Last Update Date : 12/16/2019

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