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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