Provider Demographics
NPI:1437435955
Name:PHYSICIAN HEALTHCARE NETWORK-NEUROLOGY
Entity Type:Organization
Organization Name:PHYSICIAN HEALTHCARE NETWORK-NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLIEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-385-8082
Mailing Address - Street 1:3050 COMMERCE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3819
Mailing Address - Country:US
Mailing Address - Phone:810-385-4441
Mailing Address - Fax:810-385-1540
Practice Address - Street 1:1231 PINE GROVE AVENUE
Practice Address - Street 2:SUITE 1B
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3500
Practice Address - Country:US
Practice Address - Phone:810-982-9414
Practice Address - Fax:810-985-6221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIAN HEALTHCARE NETWORK, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site