Provider Demographics
NPI:1306011440
Name:THE NEUROLOGY CENTER PLC
Entity Type:Organization
Organization Name:THE NEUROLOGY CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIMOSTHENIS
Authorized Official - Middle Name:COSTANTINOS
Authorized Official - Last Name:DAFNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-278-3412
Mailing Address - Street 1:23 N HANCHETT ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1652
Mailing Address - Country:US
Mailing Address - Phone:517-278-3412
Mailing Address - Fax:517-278-6115
Practice Address - Street 1:23 N HANCHETT ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1652
Practice Address - Country:US
Practice Address - Phone:517-278-3412
Practice Address - Fax:517-278-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073404174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI130019309OtherRAILROAD MEDICARE
MI0530097OtherIBA
MI1301200592OtherBLUE CROSS BLUE SHIELD MICHIGAN
MI0530097OtherIBA
MIG46776Medicare UPIN
IN179870Medicare PIN