| Michigan Neurology Institute-east, P.c. | |
|
25100 Kelly Rd Roseville MI 48066-4910 | |
| (586) 771-7440 | |
| (596) 771-9966 |
| Full Name | Michigan Neurology Institute-east, P.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 25100 Kelly Rd, Roseville, Michigan |
| Authorized Official Name and Position | Boris J Leheta (PRESIDENT) |
| Authorized Official Contact | 5867717488 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michigan Neurology Institute-east, P.c. 25100 Kelly Rd Roseville MI 48066-4910 Ph: (586) 771-7440 | Michigan Neurology Institute-east, P.c. 25100 Kelly Rd Roseville MI 48066-4910 Ph: (586) 771-7440 |
| NPI Number | 1922132778 |
|---|---|
| Provider Enumeration Date | 03/15/2007 |
| Last Update Date | 01/20/2015 |
| Medicare PECOS PAC ID | 7416949938 |
|---|---|
| Medicare Enrollment ID | O20040402000198 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922132778 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Paul A Cullis |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1285664680 PECOS PAC ID: 7113818451 Enrollment ID: I20040402000269 |
| Provider Name | Amer G Aboukasm |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1194754085 PECOS PAC ID: 7911042304 Enrollment ID: I20100310000464 |
| Provider Name | Cynthia A Shields |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417361361 PECOS PAC ID: 9739305210 Enrollment ID: I20140717002360 |
| Provider Name | Lusine K Kirakosyan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1669737961 PECOS PAC ID: 2264734243 Enrollment ID: I20171026001783 |
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