Healthcare Provider Details

I. General information

NPI: 1922042555
Provider Name (Legal Business Name): EDWARD J. MIKE, PH.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 EAST WARWICK DRIVE
ALMA MI
48801
US

IV. Provider business mailing address

17711 10TH AVE.
MARION MI
49665-7930
US

V. Phone/Fax

Practice location:
  • Phone: 989-466-4700
  • Fax: 231-743-2106
Mailing address:
  • Phone: 989-466-4700
  • Fax: 231-743-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301001900
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101000518
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301001900
License Number StateMI

VIII. Authorized Official

Name: DR. EDWARD J. MIKE
Title or Position: PRESIDENT
Credential: PH.D
Phone: 989-466-4700