MEDICARE: DR. NEVENA-MARIA MIHAILOFF MD

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	207Q00000X	Family Medicine Physician	NM039159	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0808242521	OTHER	MI	BCBS BCN
2	0808242521	OTHER	MI	BCN

General Provider Information

NPI Number	:	1740280569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEVENA-MARIA MIHAILOFF MD

Provider Business Mailing Address
First Line	:	1266 MARYMAR LN
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-2825
Country	:	US
Telephone Number	:	313-278-1140
Fax Number	:	313-278-0855

Provider Business Practice Location Address
First Line	:	1266 MARYMAR LN
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-2825
Country	:	US
Telephone Number	:	313-278-1140
Fax Number	:	313-278-0855

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	11/30/2016

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