MEDICARE: DR. MITCHELL S. PARKER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301011448	MI

General Provider Information

NPI Number	:	1023167517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL S. PARKER PH.D.

Provider Business Mailing Address
First Line	:	43902 WOODWARD AVE STE 110
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5021
Country	:	US
Telephone Number	:	248-338-1700
Fax Number	:	248-335-1732

Provider Business Practice Location Address
First Line	:	43902 WOODWARD AVE STE 110
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5021
Country	:	US
Telephone Number	:	248-338-1700
Fax Number	:	248-335-1732

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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