Organization
BADDIGAM FAMILY PSYCHIATRIC ASSOC
Active
Other names
Psychology Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRAMEELA BADDIGAM MD (OWNER)
(586) 263-6812
Entity
Organization
Contact information
Practice address
15500 19 MILE RD, STE 310, CLINTON TWP, MI 48038-6330
(586) 263-6812
Mailing address
15500 19 MILE RD, STE 310, CLINTON TWP, MI 48038-6330
(586) 263-6812
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
—
MI
103TC0700X
Clinical Psychologist
Primary
—
MI
103TC2200X
Clinical Child & Adolescent Psychologist
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E02096
BCBSM
MI
05
—
4769047
—
MI
05
—
4769056
—
MI
01
—
JT007751
LIC
MI
01
—
MC012228
LIC
MI
Enumeration date
12/20/2007
Last updated
12/20/2007
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