Provider Demographics
NPI:1598802076
Name:BG TRICOUNTY NEUROLOGY& SLEEP CLINIC PC
Entity Type:Organization
Organization Name:BG TRICOUNTY NEUROLOGY& SLEEP CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NARAYAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:VERMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-983-8011
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-0548
Mailing Address - Country:US
Mailing Address - Phone:248-652-7520
Mailing Address - Fax:248-652-7906
Practice Address - Street 1:31150 HOOVER RD
Practice Address - Street 2:SUITE B
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-7618
Practice Address - Country:US
Practice Address - Phone:586-983-3666
Practice Address - Fax:248-652-7906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI130E014130OtherBLUE CROSS BLUE SHIELD
MI4892425Medicaid
MI130E014130OtherBLUE CARE NETWORK