| Clinical Psychiatric Medicine Pc | |
|
0-151 44th Street Sw Grandville MI 49418 | |
| (616) 457-1889 | |
| (616) 457-1891 |
| Full Name | Clinical Psychiatric Medicine Pc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 0-151 44th Street Sw, Grandville, Michigan |
| Authorized Official Name and Position | Nan B Ah (PRESIDENT) |
| Authorized Official Contact | 6164571889 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinical Psychiatric Medicine Pc 0-151 44th Street Sw Grandville MI 49418 Ph: (616) 457-1889 | Clinical Psychiatric Medicine Pc 0-151 44th Street Sw Grandville MI 49418 Ph: (616) 457-1889 |
| NPI Number | 1386677185 |
|---|---|
| Provider Enumeration Date | 07/08/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386677185 | NPI | - | NPPES |
| 3085001 | Medicaid | MI | |
| NA045669 | Other | MI | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 4301045669 (Michigan) | Primary |
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