MEDICARE: MICHIGAN PSYCIATRIC & BEHAVIORAL ASSOCIATES

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1144322496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN PSYCIATRIC & BEHAVIORAL ASSOCIATES

Provider Business Mailing Address
First Line	:	690 S TRUMBULL ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7656
Country	:	US
Telephone Number	:	989-922-4900
Fax Number	:	989-922-4911

Provider Business Practice Location Address
First Line	:	690 S TRUMBULL ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7656
Country	:	US
Telephone Number	:	989-922-4900
Fax Number	:	989-922-4911

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. KISHORE BABU KONDAPANENI
Credential	:	D.O.
Telephone Number	:	989-922-4900

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	04/20/2008

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