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Organization

MENTAL HEALTH CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RAVINDER P MEDIRATTA M D (OWNER)
(269) 342-0606
Entity
Organization

Contact information

Practice address
1514 W MILHAM AVE, PORTAGE, MI 49024-1296
(269) 342-0606
(269) 342-0919
Mailing address
1514 W MILHAM AVE, PORTAGE, MI 49024-1296
(269) 342-0606
(269) 342-0919

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
6401009051
MI
2084P0800X
Psychiatry Physician
Primary
RM4301052512
MI

Other

Enumeration date
07/05/2007
Last updated
10/09/2008
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