# GREAT LAKES PEDIATRIC NEUROLOGY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417017476
- **Authorized official:** YASSER AWAAD MD (PRESIDENT)
- **Authorized official phone:** (248) 851-1700

## Contact information

- **Practice address:** 1331 MONROE ST, DEARBORN, MI 48124-2888
- **Practice address phone:** (248) 851-1700
- **Practice address fax:** (248) 851-3830
- **Mailing address:** 1331 MONROE ST, DEARBORN, MI 48124-2888
- **Mailing address phone:** (248) 851-1700
- **Mailing address fax:** (248) 851-3830

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 12/11/2006
- **Last updated:** 08/22/2020