Organization Active NPI

Family Neurology PLLC

  • Neurology Physician
  • Dearborn Heights, MI
National Provider Identifier
1477967313
Registry record updated Jun 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
FAMILY NEUROLOGY PLLC
Practice address
1124 Kinmore St
Dearborn Heights, MI 48127-3413
Phone
(313) 566-3880
NPI assigned
Jun 18, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2014

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

Authorized official

Name
Youssef DakkaNPI 1437367497
Title
MD
Phone
(313) 566-3880

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 1

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

Addresses

Primary practice location

1124 Kinmore St
Dearborn Heights, MI 48127-3413

Mailing address

1124 Kinmore St
Dearborn Heights, MI 48127-3413

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141224001142 MI Part B Supplier - Clinic/Group Practice 9234452244 Receives reassigned benefits from 1 practitioner
Practice locations: Dearborn, MI

National Provider Directory

National Provider Directory

Locations

2330 Monroe St
Dearborn, MI 48124
Phone (313) 455-3790

Practitioners & affiliated clinicians

Practitioners 1

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": "1403049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403568000000",
    "number": "1477967313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 KINMORE ST",
            "city": "DEARBORN HEIGHTS",
            "state": "MI",
            "postal_code": "481273413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 KINMORE ST",
            "city": "DEARBORN HEIGHTS",
            "state": "MI",
            "postal_code": "481273413",
            "telephone_number": "313-566-3880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY NEUROLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-18",
        "last_updated": "2014-06-24",
        "status": "A",
        "authorized_official_last_name": "DAKKA",
        "authorized_official_first_name": "YOUSSEF",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "313-566-3880"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn Heights, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2014; 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.