Organization
MICHIGAN NEUROSCIENCE CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMAR AHMAD M.D. (OWNER)
(313) 231-4460
Entity
Organization
Contact information
Practice address
11780 TELEGRAPH RD STE 100, TAYLOR, MI 48180-6862
(734) 374-1112
(734) 374-1119
Mailing address
PO BOX 86, TAYLOR, MI 48180-0086
(734) 374-1112
(734) 374-1119
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
4301092682
MI
2084N0400X
Neurology Physician
4301093212
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MI7264
MEDICARE PTAN LOCALITY 99
MI
Enumeration date
11/05/2013
Last updated
10/11/2023
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