Provider Demographics
NPI:1215104724
Name:FLINT NEUROSCIENCE CENTER, PLLC
Entity type:Organization
Organization Name:FLINT NEUROSCIENCE CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ-NEGRETE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-733-7560
Mailing Address - Street 1:DEPT. CH 17809
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60055-7809
Mailing Address - Country:US
Mailing Address - Phone:810-733-7560
Mailing Address - Fax:810-733-2890
Practice Address - Street 1:G3239 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3616
Practice Address - Country:US
Practice Address - Phone:810-733-7560
Practice Address - Fax:810-733-2890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLINT NEUROSCIENCE CENTER, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
700B511200OtherBCBS OF MICHIGAN
C14627OtherMEDICARE RAILROAD
C14627OtherMEDICARE RAILROAD