Healthcare Provider Details

I. General information

NPI: 1528007697
Provider Name (Legal Business Name): COMPREHENSIVE GERIATRIC SERVICES INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26811 RYAN RD
WARREN MI
48091-4075
US

IV. Provider business mailing address

4437 MCKINLEY AVE
WARREN MI
48091-1160
US

V. Phone/Fax

Practice location:
  • Phone: 586-755-4433
  • Fax: 586-755-6655
Mailing address:
  • Phone: 586-524-0672
  • 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: ROMAN J KOLODCHIN
Title or Position: OWNER
Credential: PHD
Phone: 586-755-4433