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Organization
UNIVERISTY AFFILIATED NEUROLOGISTS
Active
Organization
UNIVERISTY AFFILIATED NEUROLOGISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT LISAK M.D. (DEPARTMENT CHAIR)
(313) 577-1249
Entity
Organization
Contact information
Practice address
4201 ST. ANTOINE ST, SUITE 8D, DETROIT, MI 48201
(313) 745-4275
Mailing address
3800 WOODWARD AVE., SUITE 702, DETROIT, MI 48201
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
NULL
103G00000X
Clinical Neuropsychologist
—
—
2084N0400X
Neurology Physician
—
NULL
2084N0400X
Neurology Physician
—
—
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/30/2006
Last updated
09/11/2025
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