Provider Demographics
NPI:1922132778
Name:MICHIGAN NEUROLOGY INSTITUTE-EAST, P.C.
Entity Type:Organization
Organization Name:MICHIGAN NEUROLOGY INSTITUTE-EAST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEHETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-771-7488
Mailing Address - Street 1:25100 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4910
Mailing Address - Country:US
Mailing Address - Phone:586-771-7440
Mailing Address - Fax:596-771-9966
Practice Address - Street 1:25100 KELLY RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4910
Practice Address - Country:US
Practice Address - Phone:586-771-7440
Practice Address - Fax:596-771-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M52180Medicare PIN