Healthcare Provider Details

I. General information

NPI: 1831701671
Provider Name (Legal Business Name): PURE PSYCHIATRY OF MICHIGAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2020
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34841 VETERANS PLAZA
WAYNE MI
48184-1733
US

IV. Provider business mailing address

34841 VETERANS PLAZA
WAYNE MI
48184-1733
US

V. Phone/Fax

Practice location:
  • Phone: 313-292-7640
  • Fax: 313-292-9270
Mailing address:
  • Phone: 313-292-7640
  • Fax: 313-292-9270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: SARANG PATEL
Title or Position: PHYSICIANS ASSISTANT
Credential:
Phone: 313-292-7640