Healthcare Provider Details

I. General information

NPI: 1215711676
Provider Name (Legal Business Name): PSYCHIATRIC CONSULTANTS OF GRAND BLANC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8305 S SAGINAW ST STE 6
GRAND BLANC MI
48439-1894
US

IV. Provider business mailing address

8305 S SAGINAW ST STE 6
GRAND BLANC MI
48439-1894
US

V. Phone/Fax

Practice location:
  • Phone: 810-445-8405
  • Fax:
Mailing address:
  • Phone: 810-445-8405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PURNA SURAPANENI
Title or Position: OWNER
Credential: MD
Phone: 810-445-8405