| Premier Neurology & Pain Specialists | |
|
2211 Fort St Wyandotte MI 48192-4135 | |
| (734) 357-0505 | |
| (734) 357-0506 |
| Full Name | Premier Neurology & Pain Specialists |
|---|---|
| Speciality | Pain Medicine |
| Location | 2211 Fort St, Wyandotte, Michigan |
| Authorized Official Name and Position | Fadi Delly (OWNER) |
| Authorized Official Contact | 2487559499 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Neurology & Pain Specialists 2211 Fort St Wyandotte MI 48192-4135 Ph: (734) 357-0505 | Premier Neurology & Pain Specialists 2211 Fort St Wyandotte MI 48192-4135 Ph: (734) 357-0505 |
| NPI Number | 1992170187 |
|---|---|
| Provider Enumeration Date | 12/14/2015 |
| Last Update Date | 06/13/2019 |
| Medicare PECOS PAC ID | 1052616273 |
|---|---|
| Medicare Enrollment ID | O20160226000264 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992170187 | NPI | - | NPPES |
| Provider Name | Daniel Mekasha |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1003937798 PECOS PAC ID: 9234226374 Enrollment ID: I20071106000410 |
| Provider Name | Fadi H Delly |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1104137967 PECOS PAC ID: 4183847767 Enrollment ID: I20140529001178 |
| Provider Name | Rebecca Russo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639662349 PECOS PAC ID: 8325390776 Enrollment ID: I20181011002974 |
| Provider Name | Caitlin Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821658378 PECOS PAC ID: 9335478874 Enrollment ID: I20190910000479 |
| Provider Name | Gabrielle Monique Nadeau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497375091 PECOS PAC ID: 7810328135 Enrollment ID: I20200611000629 |
| Provider Name | Taofik Nasrat |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1275962243 PECOS PAC ID: 9133472897 Enrollment ID: I20220822002675 |
| Provider Name | Merna Kashat |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417654922 PECOS PAC ID: 3870959125 Enrollment ID: I20230511003204 |
| Provider Name | Katherine Lynn Riddle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336922244 PECOS PAC ID: 1456705334 Enrollment ID: I20230926002887 |
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