Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 6301005602 | MI |
N | 103T00000X | Psychologist | 6301005602 | MI |
N | 103TF0000X | Family Psychologist | 4101005340 | MI |
NPI | 1003852005 |
---|---|
Provider Name | Mrs. Carol Keidan |
First Address | Birmingham, MI 48009-1834 |
Second Address | Bloomfield Hills, MI 48302-5028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007336430 | AETNA (01) | MI |
028363 | VAL OPT/MCARE/BCN (01) | MI |
0911419 | BLUE CHOICE/MAGELLAN/V.O (01) | MI |
0913419 | BC MESSA (01) | MI |
130958 | CARE CHOICES (01) | MI |
181269 | COMPSYCH (01) | MA |
5266701 | AETNA (01) | MI |
7509104190 | BCBS (01) | MI |