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General NPI Number Information
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NPI Number | 1053284737
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Entity Type | Organization
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Legal Business Name | CONSCIOUS MIND PSYCHIATRY OF MICHIGAN
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 13938 MIDDLE GIBRALTAR RD
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City | GIBRALTAR
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State | MI
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Zip | 48173-9711
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Country | US
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Telephone | 313-484-3211
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Fax |
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Provider Business Mailing Address
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Address Line | 8778 THORNTREE DR
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City | GROSSE ILE
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State | MI
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Zip | 48138-1531
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT BUCKNER
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Credential | DO
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Telephone | 313-484-3211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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