Healthcare Provider Details

I. General information

NPI: 1205896123
Provider Name (Legal Business Name): MRA PSYCHIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 W WARWICK DR UNIT A
ALMA MI
48801-1115
US

IV. Provider business mailing address

PO BOX 35
ALMA MI
48801-0035
US

V. Phone/Fax

Practice location:
  • Phone: 989-423-0672
  • Fax: 989-466-6454
Mailing address:
  • Phone: 989-423-0672
  • Fax: 989-466-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number4301062869
License Number StateMI

VIII. Authorized Official

Name: DR. RAZVAN ADAM
Title or Position: PRESIDENT
Credential: MD
Phone: 989-423-0672