Individual
MICHAEL M MAKEDONSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3501 LAKE EASTBROOK BLVD SE, SUITE 222, GRAND RAPIDS, MI 49546-5940
(616) 957-0730
(616) 957-1057
Mailing address
PO BOX 1767, GRAND RAPIDS, MI 49501-1767
(616) 235-2090
(616) 235-2099
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
000656
MI
Other
Enumeration date
12/01/2005
Last updated
10/03/2011
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