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Organization
SPORTS NEUROLOGY CLINIC
Active
Organization
SPORTS NEUROLOGY CLINIC
Active
Other names
The Sports Neurology Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY KUTCHER M.D. (NATIONAL DIRECTOR)
(734) 223-4581
Entity
Organization
Contact information
Practice address
8273 GRAND RIVER RD STE 210, BRIGHTON, MI 48114-9346
(734) 223-4581
Mailing address
8273 GRAND RIVER RD STE 210, BRIGHTON, MI 48114-9346
(810) 522-6080
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
—
—
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
—
—
2084S0010X
Sports Medicine (Psychiatry & Neurology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301073973
STATE OF MICHIGAN BOARD OF MEDICINE
MI
01
—
51983
ARIZONA MEDICAL BOARD
AZ
01
—
8919590-1205
STATE OF UTAH BOARD OF MEDICINE
UT
01
—
MD.203771
LOUISIANA STATE BOARD OF MEDICAL EXAMINERS
LA
01
—
ME131286
FLORIDA DEPARTMENT OF HEALTH
FL
Enumeration date
10/09/2017
Last updated
12/05/2017
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