Healthcare Provider Details

I. General information

NPI: 1982824512
Provider Name (Legal Business Name): PSYCHIATRIC PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4461 GRAND HAVEN ROAD
MUSKEGON MI
49441
US

IV. Provider business mailing address

P.O. BOX 334
GRAND HAVEN MI
49417
US

V. Phone/Fax

Practice location:
  • Phone: 231-798-8337
  • Fax: 231-798-9816
Mailing address:
  • Phone: 231-798-8337
  • Fax: 231-798-9816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number4301066579
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301066579
License Number StateMI

VIII. Authorized Official

Name: DR. JAMES PATRICK WIADUCK
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 231-798-8337