Provider Demographics
NPI:1114186145
Name:NEUROLOGICAL INSTITUTE OF MICHIGAN PC
Entity Type:Organization
Organization Name:NEUROLOGICAL INSTITUTE OF MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANAF
Authorized Official - Middle Name:
Authorized Official - Last Name:SEID-ARABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-263-0610
Mailing Address - Street 1:15945 19 MILE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1147
Mailing Address - Country:US
Mailing Address - Phone:586-263-0610
Mailing Address - Fax:586-263-0834
Practice Address - Street 1:15945 19 MILE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1147
Practice Address - Country:US
Practice Address - Phone:586-263-0610
Practice Address - Fax:586-263-0834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010392072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH43552Medicare UPIN
MIA74641Medicare UPIN