Provider Demographics
NPI:1023539962
Name:MICHIGAN INSTITUTE OF NEUROLOGY AND EPILEPSY PC
Entity Type:Organization
Organization Name:MICHIGAN INSTITUTE OF NEUROLOGY AND EPILEPSY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BASEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSAAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-885-5650
Mailing Address - Street 1:5635 OLD CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1653
Mailing Address - Country:US
Mailing Address - Phone:248-885-5650
Mailing Address - Fax:
Practice Address - Street 1:44555 WOODWARD AVE STE 104
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5032
Practice Address - Country:US
Practice Address - Phone:248-858-6104
Practice Address - Fax:248-858-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty