MEDICARE: OPPERMAN PSYCHOLOGICAL SERVICES

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

General Provider Information

NPI Number	:	1801610530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPPERMAN PSYCHOLOGICAL SERVICES

Provider Business Mailing Address
First Line	:	711 N REMBRANDT AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-2080
Country	:	US
Telephone Number	:	319-560-3966
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 N REMBRANDT AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-2080
Country	:	US
Telephone Number	:	319-560-3966
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KIEL JAY OPPERMAN
Credential	:	PHD
Telephone Number	:	319-560-3966

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	11/11/2024

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