# KETAMINE INSTITUTE OF MICHIGAN

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ketamine Institute of Michigan South
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013526276
- **Authorized official:** DR. CHRISTA IRENE KLYDER CRNA (CHIEF CRNA)
- **Authorized official phone:** (734) 731-9500

## Contact information

- **Practice address:** 98 WINCHESTER ST STE 100, MONROE, MI 48161-1957
- **Practice address phone:** (734) 605-8500
- **Mailing address:** 98 WINCHESTER ST STE 100, MONROE, MI 48161-1957
- **Mailing address phone:** (734) 605-8500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LA0401X | Addiction Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LA0401X | Addiction Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/23/2020
- **Last updated:** 07/23/2020