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General NPI Number Information
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NPI Number | 1174836316
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Entity Type | Organization
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Legal Business Name | PREMIER NEUROPSYCHIATRY PLC
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 12/21/2010
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Provider Practice Location Address
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Address Line | 5930 LOVERS LANE
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City | PORTAGE
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State | MI
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Zip | 49002
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Country | US
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Telephone | 269-552-3900
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Fax | 269-488-3930
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Provider Business Mailing Address
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Address Line | 5930 LOVERS LANE
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City | PORTAGE
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State | MI
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Zip | 49002
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Country | US
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Telephone | 269-552-3900
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Fax | 269-488-3930
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MUKESH SANGHADIA
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Credential | M.D.
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Telephone | 269-552-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301071405
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License Number State | MI
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