Provider Demographics
NPI:1932635521
Name:SOUTH MI PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:SOUTH MI PSYCHIATRIC SERVICES LLC
Other - Org Name:KALAMAZOO TMS & BEHAVIORAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUQIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-381-6950
Mailing Address - Street 1:5930 LOVERS LN STE 3
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-1673
Mailing Address - Country:US
Mailing Address - Phone:269-381-6950
Mailing Address - Fax:269-381-6954
Practice Address - Street 1:5930 LOVERS LN STE 3
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1673
Practice Address - Country:US
Practice Address - Phone:269-381-6950
Practice Address - Fax:269-381-6954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078095103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932194214OtherNATIONAL IDENTIFICATION NUMBER
MI1598724122OtherNATIONAL IDENTIFICATION NUMBER