Healthcare Provider Details

I. General information

NPI: 1912846478
Provider Name (Legal Business Name): MIKAELA JOY MARI MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 PARKLAND PLAZA ANN ARBOR STE 110 FLOOR 1
ANN ARBOR MI
48103
US

IV. Provider business mailing address

1200 E HOSPITAL DR. D3230
ANN ARBOR MI
48109
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-4000
  • Fax: 734-539-5080
Mailing address:
  • Phone: 734-647-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351055616
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: