Provider Demographics
NPI:1982824512
Name:PSYCHIATRIC PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:PSYCHIATRIC PHYSICIANS, PLLC
Other - Org Name:JAMES P. WIADUCK, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:WIADUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-798-8337
Mailing Address - Street 1:P.O. BOX 334
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417
Mailing Address - Country:US
Mailing Address - Phone:231-798-8337
Mailing Address - Fax:231-798-9816
Practice Address - Street 1:4461 GRAND HAVEN ROAD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441
Practice Address - Country:US
Practice Address - Phone:231-798-8337
Practice Address - Fax:231-798-9816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010665792084P0015X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPTANON10230OtherPTAN ON10230