Provider Demographics
NPI:1033266408
Name:DICKINSON NEUROLOGY ASSOCIATES P C
Entity Type:Organization
Organization Name:DICKINSON NEUROLOGY ASSOCIATES P C
Other - Org Name:NEUROLOGY ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-779-7100
Mailing Address - Street 1:1205 PYLE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49802-1132
Mailing Address - Country:US
Mailing Address - Phone:906-779-7100
Mailing Address - Fax:
Practice Address - Street 1:1205 PYLE DR
Practice Address - Street 2:
Practice Address - City:KINGSFORD
Practice Address - State:MI
Practice Address - Zip Code:49802-1132
Practice Address - Country:US
Practice Address - Phone:906-779-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1477548311OtherINDIVIDUAL NPI
MI1780678318OtherINDIVIDUAL NPI
MI32635300Medicaid
MI32569100Medicaid
MI1780678318OtherINDIVIDUAL NPI
MI1477548311OtherINDIVIDUAL NPI