Healthcare Provider Details

I. General information

NPI: 1598238677
Provider Name (Legal Business Name): MICHAEL LUIS MEZA LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 PLYMOUTH RD STE 104
ANN ARBOR MI
48105-9557
US

IV. Provider business mailing address

5340 PLYMOUTH RD STE 104
ANN ARBOR MI
48105-9557
US

V. Phone/Fax

Practice location:
  • Phone: 734-433-8922
  • Fax:
Mailing address:
  • Phone: 734-433-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114983
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: