Provider Demographics
NPI:1700909843
Name:MICHIGAN NEURODIAGNOSTICS, PC
Entity Type:Organization
Organization Name:MICHIGAN NEURODIAGNOSTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEEM
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-779-2147
Mailing Address - Street 1:15142 LEVAN RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5027
Mailing Address - Country:US
Mailing Address - Phone:734-779-2147
Mailing Address - Fax:734-779-2160
Practice Address - Street 1:15142 LEVAN RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5027
Practice Address - Country:US
Practice Address - Phone:734-779-2147
Practice Address - Fax:734-779-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIST039317174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4161242 TYPE 10Medicaid
MI4161242 TYPE 10Medicaid
MID91403Medicare UPIN