| Michiana Neuroscience, Llc | |
|
210 S Race St Mishawaka IN 46544-2032 | |
| (574) 229-9695 | |
| Not Available |
| Full Name | Michiana Neuroscience, Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 210 S Race St, Mishawaka, Indiana |
| Authorized Official Name and Position | Michael Richard Mitcheff (DIRECTOR PSYCHOLOGY) |
| Authorized Official Contact | 5742299695 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michiana Neuroscience, Llc 210 S Race St Mishawaka IN 46544-2032 Ph: (574) 229-9695 | Michiana Neuroscience, Llc 210 S Race St Mishawaka IN 46544-2032 Ph: (574) 229-9695 |
| NPI Number | 1750862959 |
|---|---|
| Provider Enumeration Date | 08/24/2018 |
| Last Update Date | 08/24/2018 |
| Medicare PECOS PAC ID | 0941544712 |
|---|---|
| Medicare Enrollment ID | O20181205001056 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750862959 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 20042941A (Indiana) | Primary |
| Provider Name | Michael Mitcheff |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649624735 PECOS PAC ID: 6709185200 Enrollment ID: I20160505000599 |
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