| Greta Park, | |
| 39450 W 12 Mile Rd, Novi, MI 48377-3600 | |
| (248) 344-6688 | |
| Not Available | 
| Full Name | Greta Park | 
|---|---|
| Gender | Female | 
| Speciality | Psychiatry & Neurology - Psychiatry | 
| Location | 39450 W 12 Mile Rd, Novi, Michigan | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1225325020 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 4301099312 (Michigan) | Primary | 
| Entity Name | Henry Ford Health System | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1134144801 PECOS PAC ID: 0547178311 Enrollment ID: O20031105000139 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Greta Park, 2799 W Grand Blvd, Henry Ford Hospital, Detroit, MI 48202-2608 Ph: (313) 916-2600 | Greta Park, 39450 W 12 Mile Rd, Novi, MI 48377-3600 Ph: (248) 344-6688 | 
| Ingrid Zoraya Martinez-lyons, M.D, Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 40000 Grand River Ave Ste 306, Novi, MI 48375 Phone: 248-426-9900 Fax: 248-426-9900 | |
| Dr. Bernadette L. Angeles, M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 42450 W 12 Mile Rd, 315, Novi, MI 48377 Phone: 248-513-4100 Fax: 248-513-4105 | |
| Dominic Ernest Misiak, DO Psychiatry & Neurology Medicare: Medicare Enrolled Practice Location: 44725 Grand River Ave Ste 104, Novi, MI 48375 Phone: 517-882-3732 | |
| Dr. Vijay Samuel, M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 44000 W 12 Mile Rd., Ste 213, Novi, MI 48377 Phone: 248-347-8293 | |
| Dr. Veronica Yap Tan, M.D. Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 23354 Portage Way, Apt. 2212, Novi, MI 48375 Phone: 248-761-3939 | |
| Dr. Shanti Renee Mitchell, M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 39450 W 12 Mile Rd, Novi, MI 48377 Phone: 248-661-7393 |