MEDICARE: MS. MARGUERITE INGE MICHELS N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704106974	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4704106974	OTHER	MI	MICHIGAN LICENSE NUMBER

General Provider Information

NPI Number	:	1528098670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARGUERITE INGE MICHELS N.P.

Provider Business Mailing Address
First Line	:	43800 GARFIELD RD
Second Line	:	SUITE 200
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1136
Country	:	US
Telephone Number	:	586-228-4652
Fax Number	:	586-228-4520

Provider Business Practice Location Address
First Line	:	1150 E LANTZ ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48203-1376
Country	:	US
Telephone Number	:	313-368-4139
Fax Number	:	313-368-4470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	01/16/2009

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