Provider Demographics
NPI:1295962389
Name:NATHAN C CLAUNCH PHD PC
Entity type:Organization
Organization Name:NATHAN C CLAUNCH PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLAUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD PC
Authorized Official - Phone:734-663-9050
Mailing Address - Street 1:2225 PACKARD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104
Mailing Address - Country:US
Mailing Address - Phone:734-663-9050
Mailing Address - Fax:734-260-3573
Practice Address - Street 1:2225 PACKARD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6320
Practice Address - Country:US
Practice Address - Phone:734-663-9050
Practice Address - Fax:734-260-3573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINC1485302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680H148530OtherBLUE CROSS
MI0F34577Medicare PIN