Healthcare Provider Details

I. General information

NPI: 1962423186
Provider Name (Legal Business Name): GENESYS PRACTICE PARTNERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8435 HOLLY RD
GRAND BLANC MI
48439-1812
US

IV. Provider business mailing address

8435 HOLLY RD
GRAND BLANC MI
48439-1812
US

V. Phone/Fax

Practice location:
  • Phone: 810-424-2400
  • Fax: 810-743-1099
Mailing address:
  • Phone: 810-424-2400
  • Fax: 810-579-7222

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: JOANNE HERMAN
Title or Position: PHYSICIAN SERVICES
Credential: RN
Phone: 810-606-6364