Provider Demographics
NPI:1477967313
Name:FAMILY NEUROLOGY PLLC
Entity Type:Organization
Organization Name:FAMILY NEUROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:YOUSSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:DAKKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-566-3880
Mailing Address - Street 1:1124 KINMORE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1124 KINMORE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3413
Practice Address - Country:US
Practice Address - Phone:313-566-3880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty