Provider Demographics
NPI:1821275751
Name:JEFFREY R. KERTES, PH.D., PLC
Entity Type:Organization
Organization Name:JEFFREY R. KERTES, PH.D., PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:REUBEN
Authorized Official - Last Name:KERTES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-851-1432
Mailing Address - Street 1:7001 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 424
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3604
Mailing Address - Country:US
Mailing Address - Phone:248-626-4600
Mailing Address - Fax:248-626-3988
Practice Address - Street 1:32255 NORTHWESTERN HWY STE 60
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1505
Practice Address - Country:US
Practice Address - Phone:248-851-1432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009043103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P31030Medicare PIN