Provider Demographics
NPI:1497487524
Name:CLINICAL NEUROPHYSIOLOGY CONSULTING PLLC
Entity Type:Organization
Organization Name:CLINICAL NEUROPHYSIOLOGY CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:BURDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-977-0217
Mailing Address - Street 1:160 CAMPAU CIR NW UNIT 151
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-6100
Mailing Address - Country:US
Mailing Address - Phone:313-977-0217
Mailing Address - Fax:
Practice Address - Street 1:160 CAMPAU CIR NW UNIT 151
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-6100
Practice Address - Country:US
Practice Address - Phone:313-977-0217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty