NORTHERN MICHIGAN NEUROLOGY, P.L.C. (NPI# 1417988031) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417988031 |
| Entity Type | Organization |
| Organization Name | NORTHERN MICHIGAN NEUROLOGY, P.L.C. |
| Practice Address |
110 S Madison St Traverse City MI 49684-2340 |
| Practice Telephone | 2319350340 |
| Practice Fax Number | 2319350434 |
| Mailing Telephone | 2319350340 |
| Mailing Fax Number | 2319350434 |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2012-06-12 |
| Authorized Official Name | DR. BRADLEY K. EVANS (PROVIDER) |
| Authorized Official Telephone | 2319350340 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
BE062479 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 3067916 | 05 |
| Street Address |
110 S MADISON ST |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49684-2340 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003268202 | E. A. Austin Do PC | Psychiatry & Neurology | 110 S Madison St, Traverse City, MI 49684-2340 | 2016-07-12 |
| 1366461212 | Diane K. Donley | Psychiatry & Neurology | 110 S Madison St, Traverse City, MI 49684-2340 | 2006-07-19 |
| 1255356523 | Bradley K. Evans | Psychiatry & Neurology | 110 S Madison St, Traverse City, MI 49684-2340 | 2006-07-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124641758 | Karen Anne Paulosky | Registered Nurse | 226 S Madison St, Traverse City, MI 49684 | 2020-05-18 |
| 1891314795 | Jaclyn Elizabeth Sylvain | Student in an Organized Health Care Education/Training Program | Munson Family Practice Center, 1400 Medical Campus Drive, Traverse City, MI 49684 | 2020-04-10 |
| 1285282988 | Madelyn Drumm | Dietitian, Registered | 217 S. Madison St., Suite 3022, Traverse City, MI 49684 | 2019-08-27 |
| 1265917686 | Kacie Danielle Heading | Social Worker | 12719 S. West Bay Shore Drive, Suite 9, Traverse City, MI 49684 | 2018-10-02 |
| 1881178325 | Jacob White Ph.d., Pllc | Psychologist | 3537 W. Front Street, Suite F, Traverse City, MI 49684 | 2018-09-20 |
| 1144702572 | Constance Baab, Phd, Lmsw, Pllc | Social Worker | 3301 Veterans Drive Suite 127, Traverse City, MI 49684 | 2018-09-01 |
| 1346732880 | The Skin Cancer and Dermatology Center Plc | Dermatology | 1225 W Front St Ste 2, Traverse City, MI 49684 | 2018-05-31 |
| 1790283851 | Lisa Louise Kleyps | Massage Therapist | 3337 W. South Airport Road #2, Traverse City, MI 49684 | 2018-01-24 |
| 1114447646 | Brittany Alexandra Prior | Physical Therapist | 3899 W Front Sreet, Unit 3, Traverse City, MI 49684 | 2017-06-26 |
| 1568902963 | Jennifer Scott | Behavior Technician | 515 W 14th St Unit D, Traverse City, MI 49684 | 2017-03-03 |
| Find all providers in zip 49684 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477715076 | Erica Ann Austin | Psychiatry & Neurology | 1221 Sixth St Ste 211, Traverse City, MI 49684-2360 | 2008-06-26 |
| 1326645698 | Munson Medical Center | Psychiatry & Neurology | 1221 Sixth St, Traverse City, MI 49684-2701 | 2020-10-08 |
| 1003268202 | E. A. Austin Do PC | Psychiatry & Neurology | 110 S Madison St, Traverse City, MI 49684-2340 | 2016-07-12 |
| 1962821751 | Craig Kuesel Do Pllc | Psychiatry & Neurology | 3537 W Front St, Ste A, Traverse City, MI 49684-7941 | 2014-04-09 |
| 1871754085 | Heather K Lee | Psychiatry & Neurology | 3865 W Front St Ste 4, Traverse City, MI 49684-8102 | 2008-06-19 |
| 1013925080 | Craig Thomas Kuesel | Psychiatry & Neurology | 3537 W Front St, Ste A, Traverse City, MI 49684-7941 | 2006-08-04 |
| 1255356523 | Bradley K. Evans | Psychiatry & Neurology | 110 S Madison St, Traverse City, MI 49684-2340 | 2006-07-13 |
| 1003887290 | Martha A Frankowski | Psychiatry & Neurology | 550 Munson Ave, Traverse City, MI 49686-3580 | 2006-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134738545 | Tank Consultation Pllc | Psychiatry & Neurology | 6095 Mcallister Ct Se, Grand Rapids, MI 49546-3836 | 2020-07-31 |
| 1417578535 | Angelique Maria Manasseh | Psychiatry & Neurology | 28521 Orchard Lake Rd Ste B, Farmington Hills, MI 48334-2934 | 2020-04-29 |
| 1306473418 | International Medical Clinic Pllc | Psychiatry & Neurology | 26100 American Dr Ste 200, Southfield, MI 48034-2367 | 2020-03-26 |
| 1720636657 | Muhammad Irshad Khan | Psychiatry & Neurology | 4201 Saint Antoine St Ste Uhc -8d, Detroit, MI 48201-2153 | 2019-09-04 |
| 1992261481 | Lucid Neurology PC | Psychiatry & Neurology | 26400 W 12 Mile Rd Ste 20, Southfield, MI 48034-1774 | 2019-02-20 |
| 1417427352 | Ascension St. Mary's Hospital | Psychiatry & Neurology | 4705 Towne Centre Rd Ste 302, Saginaw, MI 48604-2819 | 2018-12-04 |
| 1205326873 | Montana Neurology Pllc | Psychiatry & Neurology | 2040 Grand River Anx Ste 200, Brighton, MI 48114 | 2018-05-18 |
| 1508353145 | Kalyan Yarraguntla | Psychiatry & Neurology | 4201 Saint Antoine St # 8c, Detroit, MI 48201-2153 | 2018-04-19 |
| 1225525389 | Ahmad Ballout | Psychiatry & Neurology | 27358 Michele St, Dearborn Heights, MI 48127-1809 | 2018-04-15 |
| 1245734730 | E.i. Neurology Associates, Pllc | Psychiatry & Neurology | 15945 19 Mile Rd Ste 106, Clinton Township, MI 48038-1147 | 2018-03-20 |
| Find all providers with the same taxonomy | ||||
| City | TRAVERSE CITY |
| Zip Code | 49684 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.