Provider Demographics
NPI:1902145659
Name:CENTER FOR INTERGRATED NEUROLOGY
Entity Type:Organization
Organization Name:CENTER FOR INTERGRATED NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-277-3334
Mailing Address - Street 1:43000 W 9 MILE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4180
Mailing Address - Country:US
Mailing Address - Phone:248-277-3334
Mailing Address - Fax:248-277-3337
Practice Address - Street 1:43000 W 9 MILE RD STE 110
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-4180
Practice Address - Country:US
Practice Address - Phone:248-277-3334
Practice Address - Fax:248-277-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010791962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty