Healthcare Provider Details

I. General information

NPI: 1487200630
Provider Name (Legal Business Name): MIA DICARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E. HOSPITAL DRIVE,CW 8-641, SPC 4254,
ANN ARBOR MI
48109-4254
US

IV. Provider business mailing address

1540 E. HOSPITAL DRIVE,CW 8-641, SPC 4254,
ANN ARBOR MI
48109-4254
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-4213
  • Fax:
Mailing address:
  • Phone: 734-936-4213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number4301516194
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: