Provider Demographics
NPI:1609299692
Name:SENIOR PSYCHIATRIC SERVICES OF MI
Entity Type:Organization
Organization Name:SENIOR PSYCHIATRIC SERVICES OF MI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:CESMAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-953-6734
Mailing Address - Street 1:38807 ANN ARBOR RD
Mailing Address - Street 2:STE. 7
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3896
Mailing Address - Country:US
Mailing Address - Phone:734-953-6734
Mailing Address - Fax:888-600-2523
Practice Address - Street 1:38807 ANN ARBOR RD
Practice Address - Street 2:STE. 7
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3896
Practice Address - Country:US
Practice Address - Phone:734-953-6734
Practice Address - Fax:888-600-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010107512084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP27820Medicare PIN