Provider Demographics
NPI:1316119498
Name:MHSDD, PC
Entity type:Organization
Organization Name:MHSDD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:LEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-543-8070
Mailing Address - Street 1:PO BOX 44047
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-0047
Mailing Address - Country:US
Mailing Address - Phone:248-543-8070
Mailing Address - Fax:248-543-9005
Practice Address - Street 1:33000 ANNAPOLIS ST
Practice Address - Street 2:SUITE 150
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2917
Practice Address - Country:US
Practice Address - Phone:734-728-3446
Practice Address - Fax:734-728-4893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P22550Medicare PIN