NPIMap

Organization Active NPI

Michigan Neuroscience Clinic PLLC

  • Neurology Physician
  • Taylor, MI
National Provider Identifier
1033548581
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
4301092682 Issued in MI
Legal business name
MICHIGAN NEUROSCIENCE CLINIC PLLC
Practice address
11780 Telegraph Rd Ste 100
Taylor, MI 48180-6862
Phone
(734) 374-1112
Fax
(734) 374-1119
NPI assigned
Nov 5, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Omar Ahmad, M.D.NPI 1568623643
Title
Owner
Phone
(313) 231-4460

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0400X 4301092682 MI Primary
Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0400X 4301093212 MI

Addresses

Primary practice location

11780 Telegraph Rd Ste 100
Taylor, MI 48180-6862

Mailing address

PO Box 86
Taylor, MI 48180-0086
Phone (734) 374-1112

Other identifiers 1

IdentifierTypeStateIssuer
MI7264OtherMIMEDICARE PTAN LOCALITY 99

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140212000321 MI Part B Supplier - Clinic/Group Practice 8820227945 Receives reassigned benefits from 6 practitioners
Practice locations: Dearborn, MI; Lincoln Park, MI; Monroe, MI; Taylor, MI; Trenton, MI; Wyandotte, MI

National Provider Directory

National Provider Directory

Locations

11780 Telegraph Rd
Ste 100
Taylor, MI 48180
Phone (734) 374-1112

5450 Fort St
Woodhaven, MI 48183
Phone (734) 671-3297

2333 Biddle Ave
Ste 8
Wyandotte, MI 48192
Phone (734) 324-3571

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HIAICA

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696982400000",
    "number": "1033548581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 86",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481800086",
            "telephone_number": "734-374-1112",
            "fax_number": "734-374-1119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11780 TELEGRAPH RD STE 100",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481806862",
            "telephone_number": "734-374-1112",
            "fax_number": "734-374-1119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN NEUROSCIENCE CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-05",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A",
        "authorized_official_last_name": "AHMAD",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-231-4460",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301092682",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301093212",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN LOCALITY 99",
            "identifier": "MI7264",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Taylor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.