Provider Demographics
NPI:1386664506
Name:DEIKIS, JOHN GINTAR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GINTAR
Last Name:DEIKIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 N FREER RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1104
Mailing Address - Country:US
Mailing Address - Phone:734-475-0942
Mailing Address - Fax:
Practice Address - Street 1:5500 ARMSTRONG RD.
Practice Address - Street 2:116A
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49016
Practice Address - Country:US
Practice Address - Phone:269-966-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008357103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service