Michigan Neurology Clinic PC

Key facts

NPI

1083166169

Entity type

Organization (NPI type 2)

Primary specialty

Neurology Physician 2084N0400X

License

4301053885 (MI)

Legal business name

MICHIGAN NEUROLOGY CLINIC PC

Practice address

31208 Beck Rd
Novi, MI 48377-1022

Phone

(248) 579-4052

NPI assigned

Oct 25, 2016

Organization subpart

No

Authorized official

Name

Bassam Maaz, M.D.

Title

President

Phone

(248) 579-4052

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 25, 2016.

{
    "created_epoch": "1477353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477353600000",
    "number": "1083166169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 128",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481210128",
            "telephone_number": "248-579-4052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31208 BECK RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483771022",
            "telephone_number": "248-579-4052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN NEUROLOGY CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-25",
        "last_updated": "2016-10-25",
        "status": "A",
        "authorized_official_last_name": "MAAZ",
        "authorized_official_first_name": "BASSAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-579-4052",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301053885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Novi, MI · Neurology Physician in Michigan