Healthcare Provider Details

I. General information

NPI: 1265623292
Provider Name (Legal Business Name): IMAGINE HEALTH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 HAYNES ST
BIRMINGHAM MI
48009-6779
US

IV. Provider business mailing address

1019 HAYNES ST
BIRMINGHAM MI
48009-6779
US

V. Phone/Fax

Practice location:
  • Phone: 248-647-3466
  • Fax: 248-647-9142
Mailing address:
  • Phone: 248-647-0391
  • Fax: 248-647-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301055165
License Number StateMI

VIII. Authorized Official

Name: DR. MARK LAWRENCE SILVERMAN
Title or Position: OWNER
Credential: M.D.
Phone: 248-647-0391