Provider Demographics
NPI:1336406552
Name:NEUROLOGY MICHIGAN PC
Entity type:Organization
Organization Name:NEUROLOGY MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MED DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GIRISH
Authorized Official - Middle Name:CHAND
Authorized Official - Last Name:MANGALICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-284-2600
Mailing Address - Street 1:1848 BIDDLE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-3962
Mailing Address - Country:US
Mailing Address - Phone:734-284-2600
Mailing Address - Fax:734-284-2666
Practice Address - Street 1:1848 BIDDLE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-3962
Practice Address - Country:US
Practice Address - Phone:734-284-2600
Practice Address - Fax:734-284-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010343772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty