Provider Demographics
NPI:1073856704
Name:CENTER FOR INTERGRATED NEUROLOGY PLC
Entity type:Organization
Organization Name:CENTER FOR INTERGRATED NEUROLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-228-0930
Mailing Address - Street 1:43000 W 9 MILE RD
Mailing Address - Street 2:STE 110
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4180
Mailing Address - Country:US
Mailing Address - Phone:248-277-3334
Mailing Address - Fax:248-277-3337
Practice Address - Street 1:43000 W 9 MILE RD
Practice Address - Street 2:STE 110
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-4180
Practice Address - Country:US
Practice Address - Phone:248-277-3334
Practice Address - Fax:248-277-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079196261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center