Healthcare Provider Details

I. General information

NPI: 1700372570
Provider Name (Legal Business Name): MIKA HANDELMAN PHD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2385 S HURON PKWY STE 2N
ANN ARBOR MI
48104-5127
US

IV. Provider business mailing address

4017 CHESTER DR APT 212
YPSILANTI MI
48197-7240
US

V. Phone/Fax

Practice location:
  • Phone: 415-939-8915
  • Fax:
Mailing address:
  • Phone: 415-939-8915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6301016807
License Number StateMI

VIII. Authorized Official

Name: DR. MIKA HANDELMAN
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 415-939-8915