| Peter M Lisiecki Phd Pc Inc | |
|
7960 W. Grand River Ste 120 Brighton MI 48114-7335 | |
| (810) 227-1999 | |
| (810) 225-2265 |
| Full Name | Peter M Lisiecki Phd Pc Inc |
|---|---|
| Speciality | Psychologist |
| Location | 7960 W. Grand River, Brighton, Michigan |
| Authorized Official Name and Position | Peter Michael Lisiecki (PRESIDENT) |
| Authorized Official Contact | 8102271999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peter M Lisiecki Phd Pc Inc 7960 Grand River Rd Ste 120 Brighton MI 48114-7335 Ph: () - | Peter M Lisiecki Phd Pc Inc 7960 W. Grand River Ste 120 Brighton MI 48114-7335 Ph: (810) 227-1999 |
| NPI Number | 1043352701 |
|---|---|
| Provider Enumeration Date | 02/12/2007 |
| Last Update Date | 06/17/2010 |
| Medicare PECOS PAC ID | 0446389381 |
|---|---|
| Medicare Enrollment ID | O20100602000392 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043352701 | NPI | - | NPPES |
| 680D745030 | Other | MI | BCBSM PIN |
| 045199 | Other | MI | VALUE OPTIONS PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 6301003173 (Michigan) | Primary |
| Provider Name | Peter Michael Lisiecki |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164744983 PECOS PAC ID: 2860521705 Enrollment ID: I20100621000366 |
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