Healthcare Provider Details

I. General information

NPI: 1558502112
Provider Name (Legal Business Name): ADAM BRIAN PLOTNICK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26105 ORCHARD LAKE RD SUITE 302
FARMINGTON HILLS MI
48334-4576
US

IV. Provider business mailing address

26105 ORCHARD LAKE RD SUITE 302
FARMINGTON HILLS MI
48334-4576
US

V. Phone/Fax

Practice location:
  • Phone: 248-471-0071
  • Fax: 248-471-1995
Mailing address:
  • Phone: 248-471-0071
  • Fax: 248-471-1995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301008823
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: