Healthcare Provider Details

I. General information

NPI: 1033393442
Provider Name (Legal Business Name): BADDIGAM FAMILY PSYCHIATRIC ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15500 19 MILE RD STE 310
CLINTON TWP MI
48038-6330
US

IV. Provider business mailing address

15500 19 MILE RD STE 310
CLINTON TWP MI
48038-6330
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-6812
  • Fax:
Mailing address:
  • Phone: 586-263-6812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. PRAMEELA BADDIGAM
Title or Position: OWNER
Credential: MD
Phone: 586-263-6812