Provider Demographics
NPI:1982983094
Name:SENIOR PSYCHIATRIC HOSPITALISTS OF MI, PLLC
Entity Type:Organization
Organization Name:SENIOR PSYCHIATRIC HOSPITALISTS OF MI, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOELZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-634-9965
Mailing Address - Street 1:3572 EMPIRE STATE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-8202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3572 EMPIRE STATE DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-8202
Practice Address - Country:US
Practice Address - Phone:734-634-9965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit