UPPER GREAT LAKES FAMILY HEALTH CENTER (NPI# 1659889673) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659889673 |
| Entity Type | Organization |
| Organization Name | UPPER GREAT LAKES FAMILY HEALTH CENTER |
| Other Organization Name | UGL MSU TELE-PSYCHIATRY |
| Practice Address |
965 Fee Rd Rm A229 East Lansing MI 48824-6410 |
| Mailing Address |
506 Campus Dr Hancock MI 49930-1569 |
| Practice Telephone | 9064831325 |
| Practice Fax Number | 9064813094 |
| Mailing Telephone | 9064831128 |
| Mailing Fax Number | 9064831122 |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2018-01-11 |
| Authorized Official Name | REBECCA GAFFNEY (BUSINESS OFFICE DIRECTOR) |
| Authorized Official Telephone | 9064831128 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| UGL MSU Tele-Psychiatry | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053948265 | Upper Great Lakes Family Health Center | Clinic/Center | 1414 W Fair Ave Ste 242, Marquette, MI 49855-5406 | 2020-03-26 |
| 1336563832 | Upper Great Lakes Family Health Center | Clinic/Center | 751 S 7th Street, Ontonagon, MI 49953-1450 | 2014-02-05 |
| 1508289273 | Upper Great Lakes Family Health Center | Clinic/Center | 1500 W Ice Lake Road, Iron River, MI 49935-8509 | 2014-01-30 |
| 1740603885 | Upper Great Lakes Family Health Center | Clinic/Center | 945 Ninth Street, Lake Linden, MI 49945-1100 | 2014-01-25 |
| 1811325103 | Upper Great Lakes Family Health Center | Clinic/Center | 600 Macinnes Drive, Houghton, MI 49931-1144 | 2013-10-23 |
| 1700103777 | Upper Great Lakes Family Health Center | Family Medicine | 301 Explorer Street, Gwinn, MI 49841-2813 | 2010-04-29 |
| 1104158690 | Upper Great Lakes Family Health Center | Family Medicine | 135 East M 35, Gwinn, MI 49841-9159 | 2010-02-08 |
| 1396295721 | Upper Great Lakes Family Health Center | Dentist | 56720 Calumet Ave, Calumet, MI 49913-1967 | 2016-10-10 |
| 1164893491 | Upper Great Lakes Family Health Center | Dentist | 301 Explorer St, Gwinn, MI 49841-2813 | 2015-10-13 |
| 1205217239 | Upper Great Lakes Family Health Center | Dentist | 1550 W Quincy St, Hancock, MI 49930-1223 | 2015-06-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | UPPER GREAT LAKES FAMILY HEALTH CENTER | 506 Campus Dr, Hancock, MI 49930-1569 |
| Street Address |
965 FEE RD RM A229 |
| City | EAST LANSING |
| State | MI |
| Zip Code | 48824-6410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528680303 | Emilia Elizabeth Mattioli | Psychiatry & Neurology | 965 Fee Road Room A223, East Lansing, MI 48824 | 2020-05-14 |
| 1447871983 | James O'brien | Psychiatry & Neurology | Msu Psychiatry Residency Program, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2020-05-06 |
| 1750916979 | Mulin Xiong | Student in an Organized Health Care Education/Training Program | 965 Wilson Road Suite A110, East Fee Hall, East Lansing, MI 48824 | 2020-03-09 |
| 1821659301 | Tovah Apolonia Aho | Psychiatry & Neurology | Michigan State University Psychiatric Residency, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-06-25 |
| 1912564881 | Asmara Theresa Hoo | Psychiatry & Neurology | 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-05-24 |
| 1790276822 | Traverse Health Clinic and Coalition | Clinic/Center | East Fee Hall 965 Fee Road, Room A222, East Lansing, MI 48824 | 2018-05-24 |
| 1922598515 | Jubin Joseph Cheruvelil | Specialist/Technologist, Other | 446 W. Circle Dr. Room 249 Annex, Justin S. Morrill Hall of Agriculture, East Lansing, MI 48824 | 2018-05-18 |
| 1073003257 | Dawn Arvye Contreras | Health Educator | 446 West Circle Dr., Justin S. Morrill Hall of Agriculture, Room 166, East Lansing, MI 48824 | 2018-05-14 |
| 1710406046 | Kimberly Ann Breukink | Social Worker | 463 East Circle Drive, Michigan State University, Counseling and Psychiatric Services, East Lansing, MI 48824 | 2017-09-19 |
| 1043766314 | Ahmed Jouan | Psychiatry & Neurology | 804 Service Rd A217, East Lansing, MI 48824 | 2016-08-28 |
| Find all providers in zip 48824 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528680303 | Emilia Elizabeth Mattioli | Psychiatry & Neurology | 965 Fee Road Room A223, East Lansing, MI 48824 | 2020-05-14 |
| 1447871983 | James O'brien | Psychiatry & Neurology | Msu Psychiatry Residency Program, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2020-05-06 |
| 1821659301 | Tovah Apolonia Aho | Psychiatry & Neurology | Michigan State University Psychiatric Residency, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-06-25 |
| 1912564881 | Asmara Theresa Hoo | Psychiatry & Neurology | 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-05-24 |
| 1508423534 | Andre Jonsson | Psychiatry & Neurology | 965 Wilson Rd Rm A233, East Lansing, MI 48824-6410 | 2019-05-24 |
| 1598250698 | Angela Elaine Smedo | Psychiatry & Neurology | 965 Fee Rd Rm 233, East Lansing, MI 48824-6410 | 2018-06-30 |
| 1326539776 | Jacob Robert Aubry | Psychiatry & Neurology | 965 Fee Rd Rm 233a, East Lansing, MI 48824-6410 | 2018-05-22 |
| 1982139325 | Hien Nguyen | Psychiatry & Neurology | 965 Fee Rd # A233, East Lansing, MI 48824-6410 | 2017-04-24 |
| 1740627330 | Nicole Albrecht Dawis | Psychiatry & Neurology | 965 Fee Rd Rm A233, East Lansing, MI 48824-6580 | 2013-05-23 |
| 1497014187 | Deepti Kaul Mughal | Psychiatry & Neurology | 965 Fee Road, Room A233, Msu & Affiliated Hospitals Psychiatry Residency Program, East Lansing, MI 48824-1316 | 2012-05-15 |
| Find all providers in EAST LANSING | ||||
| City | EAST LANSING |
| Zip Code | 48824 |
Please comment or provide details below to improve the information on UPPER GREAT LAKES FAMILY HEALTH CENTER.
| 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.