Provider Demographics
NPI:1437547460
Name:PREMIER PROFESSIONAL GROUP LLC
Entity Type:Organization
Organization Name:PREMIER PROFESSIONAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAHLIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BERKOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-513-4100
Mailing Address - Street 1:42450 W 12 MILE RD
Mailing Address - Street 2:STE 315
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3013
Mailing Address - Country:US
Mailing Address - Phone:248-513-4100
Mailing Address - Fax:248-513-4105
Practice Address - Street 1:42450 W 12 MILE RD
Practice Address - Street 2:STE 315
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3013
Practice Address - Country:US
Practice Address - Phone:248-513-4100
Practice Address - Fax:248-513-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty