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5390 Lovers Ln Third Floor Portage MI 49002 | |
| (269) 381-6950 | |
| (269) 381-6954 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5390 Lovers Ln, Portage, Michigan |
| Authorized Official Name and Position | Ruqiya Tareen (MEDICAL DIRECTOR) |
| Authorized Official Contact | 2693816950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5930 Lovers Ln Third Floor Portage MI 49002-1673 Ph: (269) 381-6950 | 5390 Lovers Ln Third Floor Portage MI 49002 Ph: (269) 381-6950 |
| NPI Number | 1114219227 |
|---|---|
| Provider Enumeration Date | 05/07/2011 |
| Last Update Date | 02/16/2016 |
| Medicare PECOS PAC ID | 7911175948 |
|---|---|
| Medicare Enrollment ID | O20110719000359 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114219227 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 4301078095 (Michigan) | Primary |
| Provider Name | Ruqiya Tareen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598724122 PECOS PAC ID: 5092742239 Enrollment ID: I20050720000240 |
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