Organization
JOLLY NEUROLOGICAL CLINIC PC
Active
Organization
JOLLY NEUROLOGICAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SURINDAR KUMAR JOLLY M.D. (PRESIDENT)
(734) 721-6001
Entity
Organization
Contact information
Practice address
4020 VENOY RD, 800, WAYNE, MI 48184-1869
(734) 721-6001
(734) 721-6003
Mailing address
4020 VENOY RD, 800, WAYNE, MI 48184-1869
(734) 721-6001
(734) 721-6003
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
SJ055782
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130H235340
BLUE CROSS BLUE SHIELD
MI
05
—
2918602
—
MI
Enumeration date
09/18/2007
Last updated
04/07/2009
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