Center for Individualized Medicine PLLC

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

4301046425 Issued in MI

Legal business name

CENTER FOR INDIVIDUALIZED MEDICINE PLLC

Practice address

1404 Biddle Ave
Wyandotte, MI 48192-3706

Phone

(734) 624-8000

Fax

(734) 326-1443

NPI assigned

Aug 7, 2013

Last updated

Aug 7, 2013By 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

Surjit S Mahal, MDNPI 1558331884

Title

Owner

Phone

(734) 324-8000

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Surjit Singh Mahal, M.D.

  • Psychiatry Physician
  • Wyandotte, MI
  • NPI 1558331884
  Authorized official Same address or phone
• Robert L. Edwards, LMSW

  • Clinical Social Worker
  • Southgate, MI
  • NPI 1932319795
  NPD (past)

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

{
    "created_epoch": "1375833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375833600000",
    "number": "1760814289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 251921",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483251921",
            "telephone_number": "734-324-8000",
            "fax_number": "734-324-0993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 BIDDLE AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481923706",
            "telephone_number": "734-624-8000",
            "fax_number": "734-326-1443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR INDIVIDUALIZED MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-07",
        "last_updated": "2013-08-07",
        "status": "A",
        "authorized_official_last_name": "MAHAL",
        "authorized_official_first_name": "SURJIT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-324-8000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MI",
            "license": "4301046425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Margaret Caretti, FNP-BC
• Carole M Rowland PHD PLLC
• Charles T Carpenter, CRNA
• Jacklyn Rae Carrico
• Shontaya Carrico, CNS
• Christian Chababi, MD
• Rebecca Gloria Chacko, M.D.
• Lance R. Chaldecott, M.D.
• Kirsten Avery Chambers, OTD, OTR/L
• Abdul-Nasser Khaled Charara, PHARMD

• Child & Adolescent Psychiatry Physician in Wyandotte, MI
• Providers in Wyandotte, MI by specialty
• Child & Adolescent Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2013; 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.