| Northern Michigan Neurology, P.l.c. | |
|
18688 Bender Trl Lake Ann MI 49650-9434 | |
| (231) 499-1037 | |
| (231) 935-0434 |
| Full Name | Northern Michigan Neurology, P.l.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 18688 Bender Trl, Lake Ann, Michigan |
| Authorized Official Name and Position | Bradley K. Evans (PROVIDER) |
| Authorized Official Contact | 2319350340 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Michigan Neurology, P.l.c. 18688 Bender Trl Lake Ann MI 49650-9434 Ph: (231) 499-1037 | Northern Michigan Neurology, P.l.c. 18688 Bender Trl Lake Ann MI 49650-9434 Ph: (231) 499-1037 |
| NPI Number | 1417988031 |
|---|---|
| Provider Enumeration Date | 07/05/2006 |
| Last Update Date | 04/20/2023 |
| Certification Date | 04/20/2023 |
| Medicare PECOS PAC ID | 8820253719 |
|---|---|
| Medicare Enrollment ID | O20120627000031 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417988031 | NPI | - | NPPES |
| 3067916 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | BE062479 (Michigan) | Primary |
| Provider Name | Bradley K Evans |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1255356523 PECOS PAC ID: 7911187034 Enrollment ID: I20110207000909 |
Northside Counseling Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 20130 Samara Trl, Lake Ann, MI 49650 Phone: 773-960-8359 |