Organization
CLINICAL PSYCHIATRIC MEDICINE PC
Active
Organization
CLINICAL PSYCHIATRIC MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NAN B AH MD (PRESIDENT)
(616) 457-1889
Entity
Organization
Contact information
Practice address
0-151 44TH STREET SW, GRANDVILLE, MI 49418
(616) 457-1889
(616) 457-1891
Mailing address
0-151 44TH STREET SW, GRANDVILLE, MI 49418
(616) 457-1889
(616) 457-1891
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301045669
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3085001
—
MI
01
—
NA045669
BLUE CROSS BLUE SHIELD
MI
Enumeration date
07/08/2006
Last updated
08/22/2020
Update your record
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