Provider Demographics
NPI:1467525675
Name:MACOMB NEUROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:MACOMB NEUROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAKRAPANI
Authorized Official - Middle Name:
Authorized Official - Last Name:RANGANATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-756-5500
Mailing Address - Street 1:PO BOX 7027
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48376
Mailing Address - Country:US
Mailing Address - Phone:586-756-5500
Mailing Address - Fax:586-756-5511
Practice Address - Street 1:27427 SCHOENHERR
Practice Address - Street 2:STE 100
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088
Practice Address - Country:US
Practice Address - Phone:586-756-5500
Practice Address - Fax:586-756-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
130E012370OtherBCBS PIN
ON27320Medicare ID - Type Unspecified