Organization
MILL STREET PSYCHIATRIC & MEDICAL CLINIC P L C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANET DELORES HEASLEY D.O. (PROVIDER)
(248) 627-7682
Entity
Organization
Contact information
Practice address
380 MILL ST, ORTONVILLE, MI 48462-8721
(248) 961-3088
(248) 627-7682
Mailing address
927 EVERGREEN RIDGE, ORTONVILLE, MI 48462-8721
(248) 961-3088
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
JH013119
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0856312505
BLUE CROSS MICHIGAN
MI
Enumeration date
04/23/2007
Last updated
08/22/2020
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