Provider Demographics
NPI:1558432203
Name:WEST MICHIGAN NEUROLOGICAL ASSOCIATES PLC
Entity Type:Organization
Organization Name:WEST MICHIGAN NEUROLOGICAL ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:GURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-231-9662
Mailing Address - Street 1:957 BROOKHAVEN CT
Mailing Address - Street 2:BLDG F
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3890
Mailing Address - Country:US
Mailing Address - Phone:855-231-9662
Mailing Address - Fax:877-252-7403
Practice Address - Street 1:957 BROOKHAVEN CT
Practice Address - Street 2:BLDG F
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3890
Practice Address - Country:US
Practice Address - Phone:855-231-9662
Practice Address - Fax:877-252-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGG0339782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1430294Medicaid
MI=========OtherTAX ID NUMBER
MI=========OtherTAX ID NUMBER
MIB44731Medicare UPIN