| Great Lakes Psychiatric Associates, Pllc | |
|
28592 Orchard Lake Rd Ste 333 Farmington Hills MI 48334-2903 | |
| (248) 865-7271 | |
| (248) 865-7274 |
| Full Name | Great Lakes Psychiatric Associates, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 28592 Orchard Lake Rd Ste 333, Farmington Hills, Michigan |
| Authorized Official Name and Position | Manzar Rajput (OWNER) |
| Authorized Official Contact | 7346190155 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Psychiatric Associates, Pllc 3517 Northbrook Dr Superior Twp MI 48198-8700 Ph: (734) 678-7450 | Great Lakes Psychiatric Associates, Pllc 28592 Orchard Lake Rd Ste 333 Farmington Hills MI 48334-2903 Ph: (248) 865-7271 |
| NPI Number | 1811452113 |
|---|---|
| Provider Enumeration Date | 01/31/2019 |
| Last Update Date | 03/28/2019 |
| Medicare PECOS PAC ID | 0749528636 |
|---|---|
| Medicare Enrollment ID | O20190219003265 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811452113 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Manzar Y Rajput |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851358527 PECOS PAC ID: 9335277987 Enrollment ID: I20100503000513 |
| Provider Name | Philicia A Richmond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740664366 PECOS PAC ID: 0840596938 Enrollment ID: I20160316001030 |
| Provider Name | Natalie N Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972056406 PECOS PAC ID: 2163710534 Enrollment ID: I20161018001814 |
| Provider Name | Shanila H Khan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891347837 PECOS PAC ID: 2163886458 Enrollment ID: I20230920000678 |
| Provider Name | Katalin Marianna Woods |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386471340 PECOS PAC ID: 7214461383 Enrollment ID: I20241112002217 |
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