SPORTS NEUROLOGY CLINIC (NPI# 1275043853) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275043853 |
| Entity Type | Organization |
| Organization Name | SPORTS NEUROLOGY CLINIC |
| Other Organization Name | THE SPORTS NEUROLOGY CLINIC |
| Practice Address |
8273 Grand River Rd Ste 210 Brighton MI 48114-9346 |
| Practice Telephone | 7342234581 |
| Mailing Telephone | 8105226080 |
| Enumeration Date | 2017-10-09 |
| Last Update Date | 2017-12-05 |
| Authorized Official Name | JEFFREY KUTCHER (NATIONAL DIRECTOR) |
| Authorized Official Telephone | 7342234581 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians | ||
| N | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
Allopathic & Osteopathic Physicians | ||
| Y | 2084S0010X |
Psychiatry & Neurology Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | STATE OF MICHIGAN BOARD OF MEDICINE | 4301073973 | 01 |
| LA | LOUISIANA STATE BOARD OF MEDICAL EXAMINERS | MD.203771 | 01 |
| FL | FLORIDA DEPARTMENT OF HEALTH | ME131286 | 01 |
| AZ | ARIZONA MEDICAL BOARD | 51983 | 01 |
| UT | STATE OF UTAH BOARD OF MEDICINE | 8919590-1205 | 01 |
| Other Name | Type Code |
|---|---|
| The Sports Neurology Clinic | Doing Business As Name - Organization |
| Street Address |
8273 GRAND RIVER RD STE 210 |
| City | BRIGHTON |
| State | MI |
| Zip Code | 48114-9346 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104112812 | Michael Jonathon Slesinski | Physical Medicine & Rehabilitation | 8273 Grand River Rd Ste 210, Brighton, MI 48114-9346 | 2011-06-21 |
| 1639729635 | Anesthesia Partners & Management Staffing LLC | Nurse Anesthetist, Certified Registered | 8273 Grand River Rd Ste 210, Brighton, MI 48114-9346 | 2019-09-12 |
| 1154804847 | Rebecca Lynn Kahn | Physician Assistant | 8273 Grand River Rd Ste 210, Brighton, MI 48114-9346 | 2018-09-10 |
| 1033578315 | Jacob Greer | Specialist/Technologist | 8273 Grand River Rd Ste 210, Brighton, MI 48114-9346 | 2016-02-16 |
| 1336530997 | Anesthesia Partners & Management LLC | Nurse Anesthetist, Certified Registered | 8273 Grand River Rd Ste 210, Brighton, MI 48114-9346 | 2015-02-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386114866 | Key Development Center, Inc. | Counselor | 2060 Grand River Annex Suite 600, Brighton, MI 48114 | 2018-11-28 |
| 1205326873 | Montana Neurology Pllc | Psychiatry & Neurology | 2040 Grand River Anx Ste 200, Brighton, MI 48114 | 2018-05-18 |
| 1205370855 | Samantha Hawley | Contractor | 73 Perch Street, Brighton, MI 48114 | 2016-12-15 |
| 1164883633 | Kathryn Degrande Lankton | Family Medicine | 7575 Grand River Ste 210, Brighton, MI 48114 | 2016-03-11 |
| 1992110241 | Bryant Castelein | Podiatrist | 7990 Grand River Rd Ste D, Brighton, MI 48114 | 2014-06-25 |
| 1033544945 | Maria Kottke | Nurse Practitioner | 3222 Eden Trl, Brighton, MI 48114 | 2013-09-10 |
| 1720380462 | Kami Erin Bartholomew | Physical Therapy Assistant | 744 Grand River, Brighton, MI 48114 | 2010-12-01 |
| 1467779223 | Amy Hund | Psychologist | 10031 Spencer Rd, Brighton, MI 48114 | 2010-05-03 |
| 1851529978 | Mark Brian Mcintee | Physician Assistant | 7575 W. Grand River, Brighton, MI 48114 | 2009-06-26 |
| 1982865432 | Disha Kinra | Dentist | 7743 Grand River Ave Ste 202, Great Expressions Dental Centers, Brighton, MI 48114 | 2008-06-18 |
| Find all providers in zip 48114 | ||||
| Taxonomy Code | 2084S0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Sports Medicine |
| A psychiatrist or neurologist who specializes in the diagnosis and treatment of sports related conditions and injuries. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Neurology and Psychiatry. |
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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.