Provider Demographics
NPI:1790395978
Name:AMIRI PSYCHIATRIC SERVICES PLLC
Entity Type:Organization
Organization Name:AMIRI PSYCHIATRIC SERVICES PLLC
Other - Org Name:MODERN MIND CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-607-7190
Mailing Address - Street 1:18000 W 9 MILE RD STE 750
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4020
Mailing Address - Country:US
Mailing Address - Phone:248-607-7190
Mailing Address - Fax:248-607-7191
Practice Address - Street 1:18000 W 9 MILE RD STE 750
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4020
Practice Address - Country:US
Practice Address - Phone:248-607-7190
Practice Address - Fax:248-607-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1154703361Medicaid