Provider Demographics
NPI:1174836316
Name:PREMIER NEUROPSYCHIATRY PLC
Entity Type:Organization
Organization Name:PREMIER NEUROPSYCHIATRY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGHADIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-552-3900
Mailing Address - Street 1:5930 LOVERS LANE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002
Mailing Address - Country:US
Mailing Address - Phone:269-552-3900
Mailing Address - Fax:269-488-3930
Practice Address - Street 1:5930 LOVERS LANE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002
Practice Address - Country:US
Practice Address - Phone:269-552-3900
Practice Address - Fax:269-488-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010714052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4396230Medicaid
1366550246OtherNPI
M05990116Medicare PIN