Healthcare Provider Details

I. General information

NPI: 1346775806
Provider Name (Legal Business Name): LINDSEY MORTENSON, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N 5TH AVE
ANN ARBOR MI
48104-1195
US

IV. Provider business mailing address

1601 BROOKLYN AVE
ANN ARBOR MI
48104-4420
US

V. Phone/Fax

Practice location:
  • Phone: 734-436-1422
  • Fax: 734-531-1990
Mailing address:
  • Phone: 734-436-1422
  • Fax: 734-531-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number4301095455
License Number StateMI

VIII. Authorized Official

Name: DR. LINDSEY MORTENSON
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 734-436-1422