Healthcare Provider Details

I. General information

NPI: 1114859881
Provider Name (Legal Business Name): NORTHSTAR EVERCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2366 OAK VALLEY DR
ANN ARBOR MI
48103-8944
US

IV. Provider business mailing address

2366 OAK VALLEY DR
ANN ARBOR MI
48103-8944
US

V. Phone/Fax

Practice location:
  • Phone: 888-247-5701
  • Fax: 888-466-7578
Mailing address:
  • Phone: 888-247-5701
  • Fax: 888-466-7578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LEE ANN MYERS
Title or Position: CAO
Credential:
Phone: 888-247-5701