# MID-MITTEN PEDIATRIC PSYCHIATRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902499767
- **Authorized official:** SAMANTHA FUGATE KENNEDY DO (PHYSICIAN/OWNER)
- **Authorized official phone:** (517) 347-8420

## Contact information

- **Practice address:** 1660 HASLETT RD STE 1, HASLETT, MI 48840-8469
- **Practice address phone:** (517) 347-8420
- **Practice address fax:** (517) 347-8420
- **Mailing address:** 1660 HASLETT RD STE 1, HASLETT, MI 48840-8469
- **Mailing address phone:** (517) 347-8420
- **Mailing address fax:** (517) 347-8420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/12/2021
- **Last updated:** 02/12/2021