Healthcare Provider Details

I. General information

NPI: 1558186288
Provider Name (Legal Business Name): RMG MICHIGAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W PINE LAKE DR
NEWAYGO MI
49337-9264
US

IV. Provider business mailing address

81 ROANOKE AVE
FAIRFIELD CT
06824-6124
US

V. Phone/Fax

Practice location:
  • Phone: 231-652-4618
  • Fax:
Mailing address:
  • Phone: 203-430-1321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: OMAR ZIYADEH
Title or Position: CEO
Credential:
Phone: 203-430-1321