| Jolly Neurological Clinic Pc | |
|
4020 Venoy Rd 800 Wayne MI 48184-1869 | |
| (734) 721-6001 | |
| (734) 721-6003 |
| Full Name | Jolly Neurological Clinic Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4020 Venoy Rd, Wayne, Michigan |
| Authorized Official Name and Position | Surindar Kumar Jolly (PRESIDENT) |
| Authorized Official Contact | 7347216001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jolly Neurological Clinic Pc 4020 Venoy Rd 800 Wayne MI 48184-1869 Ph: (734) 721-6001 | Jolly Neurological Clinic Pc 4020 Venoy Rd 800 Wayne MI 48184-1869 Ph: (734) 721-6001 |
| NPI Number | 1407042922 |
|---|---|
| Provider Enumeration Date | 09/18/2007 |
| Last Update Date | 04/07/2009 |
| Medicare PECOS PAC ID | 1759461460 |
|---|---|
| Medicare Enrollment ID | O20080108000387 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407042922 | NPI | - | NPPES |
| 130H235340 | Other | MI | BLUE CROSS BLUE SHIELD |
| 2918602 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | SJ055782 (Michigan) | Primary |
| Provider Name | Surindar Kumar Jolly |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1164479911 PECOS PAC ID: 9436118718 Enrollment ID: I20041004000893 |
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