Organization
MICHIGAN NEUROLOGY ASSOCIATES OPT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE FRECK (OFFICE MANAGER)
(586) 445-9900
Entity
Organization
Contact information
Practice address
19699 E 8 MILE RD, SAINT CLAIR SHORES, MI 48080-1655
(586) 445-9900
Mailing address
19699 E 8 MILE RD, SAINT CLAIR SHORES, MI 48080-1655
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
TG008581
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30858
FACILITY
MI
Enumeration date
08/23/2007
Last updated
08/23/2007
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