Healthcare Provider Details

I. General information

NPI: 1346334240
Provider Name (Legal Business Name): PSYCHIATRY SUBSPECIALTIES CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E CHICAGO ST
COLDWATER MI
49036-2046
US

IV. Provider business mailing address

1131 N OSSEO RD
HILLSDALE MI
49242-9714
US

V. Phone/Fax

Practice location:
  • Phone: 517-279-0248
  • Fax:
Mailing address:
  • Phone: 517-523-3695
  • Fax: 517-523-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberSL078982
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberSL078982
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberFC067134
License Number StateMI

VIII. Authorized Official

Name: FERNANDO CASTRO-URRUTIA
Title or Position: CEO
Credential: M.D.
Phone: 517-279-0248