Provider Demographics
NPI:1003004086
Name:MICHIGAN ADVANCED NEUROLOGY CENTER, PLLC
Entity Type:Organization
Organization Name:MICHIGAN ADVANCED NEUROLOGY CENTER, PLLC
Other - Org Name:MANC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-799-2770
Mailing Address - Street 1:4705 TOWNE CTR
Mailing Address - Street 2:STE. 201
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2818
Mailing Address - Country:US
Mailing Address - Phone:989-799-2770
Mailing Address - Fax:989-799-2737
Practice Address - Street 1:4705 TOWNE CTR
Practice Address - Street 2:STE. 201
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2818
Practice Address - Country:US
Practice Address - Phone:989-799-2770
Practice Address - Fax:989-799-2737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDM0667282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4695041Medicaid
MI4695041Medicaid
MI001Medicare PIN