NPIMap

Organization Active NPI

Fadi Delly, MD PC

Doing business as Premier Neurology & Pain Specialists

  • Interventional Pain Medicine Physician
  • Wyandotte, MI
National Provider Identifier
1992170187
Registry record updated Jun 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
4301094922 Issued in MI
Legal business name
FADI DELLY, MD PC
Doing business as
Premier Neurology & Pain Specialists
Practice address
2211 Fort St
Wyandotte, MI 48192-4135
Phone
(734) 357-0505
Fax
(734) 357-0506
NPI assigned
Dec 14, 2015
Last updated
Jun 13, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2019

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

Authorized official

Name
Mr. Fadi Delly, M.D.NPI 1104137967
Title
Owner
Phone
(248) 755-9499

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromuscular Medicine (Psychiatry & Neurology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0008X 4301094922 MI
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X 4301094922 MI
Pain Medicine (Psychiatry & Neurology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P2900X 4301094922 MI
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X 4301094922 MI Primary

Addresses

Primary practice location

2211 Fort St
Wyandotte, MI 48192-4135

Mailing address

2211 Fort St
Wyandotte, MI 48192-4135
Phone (734) 357-0505

Other names 1

  • Premier Neurology & Pain Specialists Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160226000264 MI Part B Supplier - Clinic/Group Practice 1052616273 Receives reassigned benefits from 12 practitioners
Practice locations: Southgate, MI; Wyandotte, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1450051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560384000000",
    "number": "1992170187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 FORT ST",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481924135",
            "telephone_number": "734-357-0505",
            "fax_number": "734-357-0506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 FORT ST",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481924135",
            "telephone_number": "734-357-0505",
            "fax_number": "734-357-0506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FADI DELLY, MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-14",
        "last_updated": "2019-06-13",
        "status": "A",
        "authorized_official_last_name": "DELLY",
        "authorized_official_first_name": "FADI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-755-9499",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0008X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neuromuscular Medicine",
            "state": "MI",
            "license": "4301094922",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301094922",
            "primary": false
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": "MI",
            "license": "4301094922",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "MI",
            "license": "4301094922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Neurology & Pain Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Premier Neurology & Pain Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wyandotte, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2019; 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.