Ketamine Institute of Michigan

Primary specialty

Addiction Medicine (Anesthesiology) PhysicianTaxonomy code 207LA0401X

Legal business name

KETAMINE INSTITUTE OF MICHIGAN

Practice address

98 Winchester St Ste 100
Monroe, MI 48161-1957

Phone

(734) 605-8500

NPI assigned

Jul 23, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Christa Irene Klyder, CRNA

Title

Chief Crna

Phone

(734) 731-9500

Specialties & licenses 1

Addresses

Other names 1

• Ketamine Institute of Michigan South Doing business as

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595462400000",
    "number": "1013526276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 WINCHESTER ST STE 100",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481611957",
            "telephone_number": "734-605-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 WINCHESTER ST STE 100",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481611957",
            "telephone_number": "734-605-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE INSTITUTE OF MICHIGAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-23",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A",
        "authorized_official_last_name": "KLYDER",
        "authorized_official_first_name": "CHRISTA",
        "authorized_official_middle_name": "IRENE",
        "authorized_official_title_or_position": "CHIEF CRNA",
        "authorized_official_telephone_number": "734-731-9500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207LA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "completeketamine.com",
            "affiliation": "N",
            "endpointDescription": "website",
            "address_1": "98 Winchester St Ste 100",
            "city": "Monroe",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481611957",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Ketamine Institute of Michigan South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tammie L Kelley Stahr, RN
• Jennifer Ann Kelley, LMSW
• Timothy James Kellie, CNP
• Lisa Marie Kelly, APRN
• Oscar Kelly
• Phyllis Ann Kettlewell, CRNA
• Azadeh Khaghany, M.D.
• Ashar Humayun Khan, MD
• Shahid Khan, OTR
• Umar Khan

• Addiction Medicine (Anesthesiology) Physician in Monroe, MI
• Providers in Monroe, MI by specialty
• Addiction Medicine (Anesthesiology) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.