Healthcare Provider Details

I. General information

NPI: 1740743616
Provider Name (Legal Business Name): RICHELLE PAULINA PAYEA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 08/25/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 E BELTLINE AVE SE
GRAND RAPIDS MI
49506-4300
US

IV. Provider business mailing address

1310 E BELTLINE AVE SE
GRAND RAPIDS MI
49506-4300
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-1500
  • Fax:
Mailing address:
  • Phone: 616-252-4560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number4301509660
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4351044078
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: