| Kelatess Pc | |
|
1441 E Maple Ave Burton MI 48529-2059 | |
| (810) 820-6265 | |
| Not Available |
| Full Name | Kelatess Pc |
|---|---|
| Speciality | Psychologist |
| Location | 1441 E Maple Ave, Burton, Michigan |
| Authorized Official Name and Position | Matthew P. Dickson (PRESIDENT) |
| Authorized Official Contact | 8106061099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelatess Pc 7382 Mohansic Dr Bloomfield Hills MI 48301-3552 Ph: (810) 606-1099 | Kelatess Pc 1441 E Maple Ave Burton MI 48529-2059 Ph: (810) 820-6265 |
| NPI Number | 1659305860 |
|---|---|
| Provider Enumeration Date | 07/11/2006 |
| Last Update Date | 11/30/2016 |
| Medicare PECOS PAC ID | 0648240895 |
|---|---|
| Medicare Enrollment ID | O20040727000770 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659305860 | NPI | - | NPPES |
| 680F33159 | Other | MI | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6301006835 (Michigan) | Primary |
| Provider Name | Matthew P Dickson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437321502 PECOS PAC ID: 9234109497 Enrollment ID: I20040727001046 |
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