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General NPI Number Information
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NPI Number | 1982824512
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC PHYSICIANS, PLLC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 4461 GRAND HAVEN ROAD
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City | MUSKEGON
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State | MI
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Zip | 49441
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Country | US
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Telephone | 231-798-8337
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Fax | 231-798-9816
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Provider Business Mailing Address
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Address Line | P.O. BOX 334
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City | GRAND HAVEN
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State | MI
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Zip | 49417
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Country | US
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Telephone | 231-798-8337
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Fax | 231-798-9816
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JAMES PATRICK WIADUCK
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Credential | M.D.
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Telephone | 231-798-8337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | 4301066579
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301066579
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License Number State | MI
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