| Northwest Neurology And Neurodiagnostic Center | |
|
27200 Lahser Rd Suite 100 Southfield MI 48034-2137 | |
| (248) 208-9215 | |
| (248) 208-9217 |
| Full Name | Northwest Neurology And Neurodiagnostic Center |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 27200 Lahser Rd, Southfield, Michigan |
| Authorized Official Name and Position | Tessy C Jenkins (PRESIDENT) |
| Authorized Official Contact | 2482089215 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwest Neurology And Neurodiagnostic Center 27200 Lahser Rd Suite 100 Southfield MI 48034-2137 Ph: (248) 208-9215 | Northwest Neurology And Neurodiagnostic Center 27200 Lahser Rd Suite 100 Southfield MI 48034-2137 Ph: (248) 208-9215 |
| NPI Number | 1467576132 |
|---|---|
| Provider Enumeration Date | 03/19/2007 |
| Last Update Date | 10/18/2010 |
| Medicare PECOS PAC ID | 1355300476 |
|---|---|
| Medicare Enrollment ID | O20041005000903 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467576132 | NPI | - | NPPES |
| 4639614 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 4301058568 (Michigan) | Primary |
| Provider Name | Tessy C Jenkins |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1548269897 PECOS PAC ID: 1355328063 Enrollment ID: I20040701000183 |
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