Provider Demographics
NPI:1700118759
Name:NEUROLOGICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:NEUROLOGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAREZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-285-7880
Mailing Address - Street 1:20600 EUREKA RD
Mailing Address - Street 2:SUITE 801
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-5343
Mailing Address - Country:US
Mailing Address - Phone:734-285-7880
Mailing Address - Fax:734-285-2020
Practice Address - Street 1:20600 EUREKA RD
Practice Address - Street 2:SUITE 801
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5343
Practice Address - Country:US
Practice Address - Phone:734-285-7880
Practice Address - Fax:734-285-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAB034772207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2732271Medicaid
MIE21192Medicare UPIN
MI0827915Medicare PIN