Mid Michigan Ketamine Clinic PLLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

MID MICHIGAN KETAMINE CLINIC PLLC

Practice address

245 E Warwick Dr
Alma, MI 48801-1026

Phone

(313) 203-6002

NPI assigned

Jun 5, 2022

Last updated

Jun 7, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Antonietta Elizabeth Walker, MHSA

Title

Partner

Phone

(810) 523-5194

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1654387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654560000000",
    "number": "1316676547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68490 MEADOWOOD CT",
            "city": "WASHINGTON",
            "state": "MI",
            "postal_code": "480951395",
            "telephone_number": "810-523-5194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 E WARWICK DR",
            "city": "ALMA",
            "state": "MI",
            "postal_code": "488011026",
            "telephone_number": "313-203-6002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID MICHIGAN KETAMINE CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-05",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "ANTONIETTA",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "810-523-5194",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MHSA"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michigan Masonic Home (Warwick Living Center)
• Michigan Masonic Home (Masonic Pathways)
• Michigan Masonic Home (Masonic Pathways)
• Michigan Radiation Medicine PLLC
• Pamela S Micko
• Mid-Michigan Health Care Associates,LTD (Warwick Living Center)
• Mid-Michigan Radiology Associates, PC
• Midmichigan Home Health Services (Gratiot Home Medical)
• Midmichigan Visiting Nurse Association (MidMichigan Home Care)
• Stacey Mikowski

• Health Service Clinic/Center in Alma, MI
• Providers in Alma, MI by specialty
• Health Service Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2022; 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.