Provider Demographics
NPI:1609111350
Name:PSYCHOLOGICAL INSTITUTES OF MICHIGAN, P.C.
Entity Type:Organization
Organization Name:PSYCHOLOGICAL INSTITUTES OF MICHIGAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:ERARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-626-4622
Mailing Address - Street 1:7457 FRANKLIN ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BLOOMFIELD TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48301
Mailing Address - Country:US
Mailing Address - Phone:248-626-4622
Mailing Address - Fax:248-626-2908
Practice Address - Street 1:7457 FRANKLIN ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:BLOOMFIELD TWP
Practice Address - State:MI
Practice Address - Zip Code:48301
Practice Address - Country:US
Practice Address - Phone:248-626-4622
Practice Address - Fax:248-626-2908
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSYCHOLOGICAL INSTITUTES OF MICHIGAN, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-06
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011628103TC0700X
MI4704102153363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447300694OtherNPI
0F37073Medicare UPIN