Provider Demographics
NPI:1134178064
Name:GANLEY,GILROY NEUROLOGY P.C.
Entity type:Organization
Organization Name:GANLEY,GILROY NEUROLOGY P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-723-4488
Mailing Address - Street 1:31500 TELEGRAPH RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4367
Mailing Address - Country:US
Mailing Address - Phone:248-723-4488
Mailing Address - Fax:248-723-4481
Practice Address - Street 1:31500 TELEGRAPH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4367
Practice Address - Country:US
Practice Address - Phone:248-723-4488
Practice Address - Fax:248-723-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114157491Medicaid
MI130F375610OtherBLUE CROSS BLUE SHIELD
MI130F375610OtherBLUE CROSS BLUE SHIELD
MI114157491Medicaid