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NPI Code Detail

MEDICARE: PAUL HEWITT PSYD

MEDICARE: PAUL HEWITT PSYD
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
1103TC0700XClinical Psychologist6301013946MI

General Provider Information

NPI Number : 1851549745
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL HEWITT PSYD
Provider Business Mailing Address
First Line : 1870 LEONARD ST NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49505-5650
Country : US
Telephone Number : 616-956-1122
Fax Number : 616-956-8033
Provider Business Practice Location Address
First Line : 1870 LEONARD ST NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49505-5650
Country : US
Telephone Number : 616-956-1122
Fax Number : 616-956-8033
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2008
Last Update Date : 09/04/2008

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