Provider Demographics
NPI:1164636551
Name:MICHIGAN NEUROLOGY PC
Entity Type:Organization
Organization Name:MICHIGAN NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHHEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-720-7801
Mailing Address - Street 1:5154 MILLER RD STE I
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1069
Mailing Address - Country:US
Mailing Address - Phone:810-720-7801
Mailing Address - Fax:810-720-7803
Practice Address - Street 1:5154 MILLER RD STE I
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1069
Practice Address - Country:US
Practice Address - Phone:810-720-7801
Practice Address - Fax:810-720-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045264261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301045264OtherSTATE LIC
MI3512502562OtherHEALTH PLUS
MI1001175OtherMCLAREN
MI3502502562OtherBC
MI101OtherCOMMUNITY CHOICE
MI4301045264OtherSTATE LIC
MIB45420Medicare UPIN
MI1001175OtherMCLAREN
MI0P24510Medicare PIN