Organization
PETER M LISIECKI PHD PC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER MICHAEL LISIECKI (PRESIDENT)
(810) 227-1999
Entity
Organization
Contact information
Practice address
7960 W. GRAND RIVER, STE 120, BRIGHTON, MI 48114-7335
(810) 227-1999
(810) 225-2265
Mailing address
7960 GRAND RIVER RD STE 120, BRIGHTON, MI 48114-7335
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301003173
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045199
VALUE OPTIONS PIN
MI
01
—
680D745030
BCBSM PIN
MI
Enumeration date
02/12/2007
Last updated
06/17/2010
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