Healthcare Provider Details

I. General information

NPI: 1982983094
Provider Name (Legal Business Name): SENIOR PSYCHIATRIC HOSPITALISTS OF MI, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2011
Last Update Date: 08/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3572 EMPIRE STATE DR
CANTON MI
48188-8202
US

IV. Provider business mailing address

3572 EMPIRE STATE DR
CANTON MI
48188-8202
US

V. Phone/Fax

Practice location:
  • Phone: 734-634-9965
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: DEBRA KOELZER
Title or Position: MANAGER
Credential:
Phone: 734-634-9965