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Organization
UNIVERSITY MEDICAL SPECIALTIES, PC
Active
Organization
UNIVERSITY MEDICAL SPECIALTIES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAEANN DANENE LONG (OFFICE MANAGER)
(269) 473-2222
Entity
Organization
Contact information
Practice address
9045 US HIGHWAY 31, BERRIEN SPRINGS, MI 49103-1804
(269) 473-2222
(269) 473-6880
Mailing address
9045 US HIGHWAY 31, BERRIEN SPRINGS, MI 49103-1804
(269) 473-2222
(269) 473-6880
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
FK271098
MI
103T00000X
Psychologist
LH009414
MI
103T00000X
Psychologist
NC007536
MI
207Q00000X
Family Medicine Physician
Primary
DR064962
MI
207Q00000X
Family Medicine Physician
LH052398
MI
207R00000X
Internal Medicine Physician
KK081055
MI
208000000X
Pediatrics Physician
KK081055
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680A112130
GROUP MENTAL HEALTH BCBSM PIN
MI
01
—
700A146860
MEDICAL GROUP BCBSM PIN
MI
Enumeration date
11/09/2007
Last updated
10/16/2008
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