Healthcare Provider Details

I. General information

NPI: 1093699985
Provider Name (Legal Business Name): MICHIGAN HEALTHCARE PROFESSIONALS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 ALLEN RD
ALLEN PARK MI
48101-1705
US

IV. Provider business mailing address

29992 NORTHWESTERN HWY STE C
FARMINGTON HILLS MI
48334-3292
US

V. Phone/Fax

Practice location:
  • Phone: 313-386-0080
  • Fax: 313-383-7150
Mailing address:
  • Phone: 248-851-1430
  • Fax: 248-851-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: AUGHTUM HALSEY
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 248-780-6615