Healthcare Provider Details

I. General information

NPI: 1063195303
Provider Name (Legal Business Name): NINA C MICHON MA, TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S 5TH AVE
ANN ARBOR MI
48104-2216
US

IV. Provider business mailing address

210 S 5TH AVE
ANN ARBOR MI
48104-2216
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-3471
  • Fax:
Mailing address:
  • Phone: 734-764-3471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number6352001251
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: