Healthcare Provider Details

I. General information

NPI: 1457551756
Provider Name (Legal Business Name): MPA GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 S EUCLID AVE
BAY CITY MI
48706-3311
US

IV. Provider business mailing address

1217 S EUCLID AVE
BAY CITY MI
48706-3311
US

V. Phone/Fax

Practice location:
  • Phone: 989-667-9661
  • Fax: 989-667-9680
Mailing address:
  • Phone: 989-667-9661
  • Fax: 989-667-9680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number4301026598
License Number StateMI

VIII. Authorized Official

Name: MR. RONALD D. LEIX
Title or Position: CEO
Credential: M.B.A.
Phone: 989-667-9661