| Cognosis Health Hillside | |
|
5445 Ali Dr Dept 320 Grand Blanc MI 48439-5193 | |
| (810) 428-1181 | |
| (810) 426-0009 |
| Full Name | Cognosis Health Hillside |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5445 Ali Dr Dept 320, Grand Blanc, Michigan |
| Authorized Official Name and Position | Justin Kurt Liegmann (MANAGING MEMBER) |
| Authorized Official Contact | 8104281181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cognosis Health Hillside 5445 Ali Dr Dept 320 Grand Blanc MI 48439-5193 Ph: (810) 428-1181 | Cognosis Health Hillside 5445 Ali Dr Dept 320 Grand Blanc MI 48439-5193 Ph: (810) 428-1181 |
| NPI Number | 1326726605 |
|---|---|
| Provider Enumeration Date | 07/07/2023 |
| Last Update Date | 12/06/2023 |
| Certification Date | 11/30/2023 |
| Medicare PECOS PAC ID | 5890158901 |
|---|---|
| Medicare Enrollment ID | O20230822003625 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326726605 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Dennis H Ward |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184751513 PECOS PAC ID: 4587617022 Enrollment ID: I20050224000814 |
| Provider Name | Michele J Gustafson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437261948 PECOS PAC ID: 9234268459 Enrollment ID: I20100526001095 |
| Provider Name | James H Dearlove |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932211901 PECOS PAC ID: 5698804813 Enrollment ID: I20100526001103 |
| Provider Name | Wendy L Osika |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740392950 PECOS PAC ID: 6709915705 Enrollment ID: I20100601000742 |
| Provider Name | Carol Osborn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740392067 PECOS PAC ID: 1153451984 Enrollment ID: I20100604000819 |
| Provider Name | Purna R Surapaneni |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154429934 PECOS PAC ID: 7214125061 Enrollment ID: I20101221000941 |
| Provider Name | Justin Liegmann |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750513099 PECOS PAC ID: 6800020983 Enrollment ID: I20131002000618 |
| Provider Name | Kevin B Stachowiak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598877714 PECOS PAC ID: 3072741016 Enrollment ID: I20140120000632 |
| Provider Name | Mary E Tinklepaugh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245654441 PECOS PAC ID: 0345466645 Enrollment ID: I20140722002728 |
| Provider Name | Janet Popp |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750803870 PECOS PAC ID: 5597037176 Enrollment ID: I20170816002610 |
| Provider Name | Sharon Longbucco |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639686272 PECOS PAC ID: 8527497353 Enrollment ID: I20200331000455 |
| Provider Name | Robert Bates |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1598868622 PECOS PAC ID: 4082027859 Enrollment ID: I20210115001912 |
| Provider Name | Alicia M Wofford |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861839839 PECOS PAC ID: 4486008281 Enrollment ID: I20240227001781 |
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