Provider Demographics
NPI:1548447709
Name:SPECIALISTS IN PSYCHIATRIC PHARMACOLOGY PLLC
Entity type:Organization
Organization Name:SPECIALISTS IN PSYCHIATRIC PHARMACOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-723-3222
Mailing Address - Street 1:1000 S OLD WOODWARD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6723
Mailing Address - Country:US
Mailing Address - Phone:248-723-3222
Mailing Address - Fax:248-723-3226
Practice Address - Street 1:1000 S OLD WOODWARD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6723
Practice Address - Country:US
Practice Address - Phone:248-723-3222
Practice Address - Fax:248-723-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2658212294OtherBLUE CROSS BLUE SHIELD ID
MI260F301540OtherBCBS GROUP ID
MI2658205874OtherBLUE CROSS BLUE SHIELD ID
MI0N71820Medicare PIN
MI0N71820003Medicare PIN
MI2658212294OtherBLUE CROSS BLUE SHIELD ID