David Robert Dietrich, PH.D.
Individual provider Active NPI Psychoanalyst · Birmingham, MI
NPI 1992969224 · NPPES record last updated Jul 16, 2008
Key facts
- NPI
- 1992969224
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychoanalyst 102L00000X
- License
- 6301003061 (MI)
- Practice address
- 625 Purdy St
Birmingham, MI 48009-1738 - Phone
- (248) 646-6515
- Fax
- (248) 646-2760
- NPI assigned
- Jul 16, 2008
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301003061 | MI | MD | Psychoanalyst |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychoanalyst | 102L00000X | 6301003061 | MI | Yes |
| Psychoanalyst | 102L00000X |
Addresses
Primary practice location
625 Purdy St
Birmingham, MI 48009-1738
Mailing address
625 Purdy St
Birmingham, MI 48009-1738
Phone (248) 646-6515
Other providers in Birmingham, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.