| Center For Individualized Medicine Pllc | |
|
1404 Biddle Ave Wyandotte MI 48192-3706 | |
| (734) 624-8000 | |
| (734) 326-1443 |
| Full Name | Center For Individualized Medicine Pllc |
|---|---|
| Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
| Location | 1404 Biddle Ave, Wyandotte, Michigan |
| Authorized Official Name and Position | Surjit S Mahal (OWNER) |
| Authorized Official Contact | 7343248000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Individualized Medicine Pllc Po Box 251921 West Bloomfield MI 48325-1921 Ph: (734) 324-8000 | Center For Individualized Medicine Pllc 1404 Biddle Ave Wyandotte MI 48192-3706 Ph: (734) 624-8000 |
| NPI Number | 1760814289 |
|---|---|
| Provider Enumeration Date | 08/07/2013 |
| Last Update Date | 08/07/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760814289 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 4301046425 (Michigan) | Primary |
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