Provider Demographics
NPI:1366895559
Name:MICHIGAN NEUROLOGY ASSOCIATES DME
Entity type:Organization
Organization Name:MICHIGAN NEUROLOGY ASSOCIATES DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MNA
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANCARLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-445-9900
Mailing Address - Street 1:34025 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-3737
Mailing Address - Country:US
Mailing Address - Phone:586-445-9900
Mailing Address - Fax:586-445-2641
Practice Address - Street 1:11051 HALL RD
Practice Address - Street 2:STE 240
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5735
Practice Address - Country:US
Practice Address - Phone:586-323-9900
Practice Address - Fax:586-323-5051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHIGAN NEUROLOGY ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies