KETAMINE INSTITUTE OF MICHIGAN (NPI# 1013526276) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013526276 |
| Entity Type | Organization |
| Organization Name | KETAMINE INSTITUTE OF MICHIGAN |
| Practice Address |
98 Winchester St Ste 100 Monroe MI 48161-1957 |
| Practice Telephone | 7346058500 |
| Mailing Telephone | 7346058500 |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2020-07-23 |
| Authorized Official Name | DR. CHRISTA IRENE KLYDER (CHIEF CRNA) |
| Authorized Official Telephone | 7347319500 |
| Authorized Official Credential | CRNA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207LA0401X |
Anesthesiology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Ketamine Institute of Michigan South | Doing Business As Name - Organization |
| Street Address |
98 WINCHESTER ST STE 100 |
| City | MONROE |
| State | MI |
| Zip Code | 48161-1957 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164980967 | James Abrams | Behavior Technician | 2086 South Custer Road, Monroe, MI 48161 | 2019-03-11 |
| 1457841504 | Teresa Anne Clark-jones | Health Educator | Msu Extension Monroe County, 963 S. Raisinville Rd., Monroe, MI 48161 | 2018-05-15 |
| 1174045215 | Ariane E Combs | Counselor | 25 S. Monroe Street, Suite 205, Monroe, MI 48161 | 2017-07-11 |
| 1518341650 | Jennifer Statler | Physical Therapist | 1380 Lake Dr, Unit B, Monroe, MI 48161 | 2015-07-18 |
| 1811376742 | Rainbow Center of Michigan, Inc | Community/Behavioral Health | 14733 S. Telegraph Rd, Monroe, MI 48161 | 2015-05-26 |
| 1356743371 | Samantha Rose Dehring | Counselor | Recovery Zone Counseling, Pllc, 49 South Monroe St. (suite# 175), Monroe, MI 48161 | 2014-09-22 |
| 1598105074 | Busharat Ahmad | Ophthalmology | 774 Windsor Court, Monroe, MI 48161 | 2013-06-28 |
| 1225371032 | Anissa Castelluzzo | Nurse Practitioner | 975 S Monroe St Ste C, Monroe, MI 48161 | 2013-03-29 |
| 1811256274 | Paul Mikels Lmsw LLC | Social Worker | 986 S. Telegraph Rd, Monroe, MI 48161 | 2012-05-04 |
| 1225306798 | Paula Stanifer | Counselor | 14930 Laplaisance Rd #123, Monroe, MI 48161 | 2011-12-12 |
| Find all providers in zip 48161 | ||||
| Taxonomy Code | 207LA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Addiction Medicine |
| An anesthesiologist who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427452176 | Dettmann Center | Anesthesiology | 3501 Lake Eastbrook Blvd Se Ste 100, Grand Rapids, MI 49546-5939 | 2014-10-09 |
| 1972946374 | Jeffry Edward Hagenstein | Anesthesiology | 1163 Tumbleweed Ct., Flint, MI 48532 | 2013-04-16 |
| 1336422948 | Spectrum Health Primary Care Partners | Anesthesiology | 75 Sheldon Blvd Se, Grand Rapids, MI 49503-4224 | 2011-09-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.