Healthcare Provider Details

I. General information

NPI: 1740461185
Provider Name (Legal Business Name): RENEE ANNETTE MIROVSKY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CROSS CREEK PKWY STE 220
AUBURN HILLS MI
48326-2776
US

IV. Provider business mailing address

43411 GARFIELD RD STE B
CLINTON TOWNSHIP MI
48038-1152
US

V. Phone/Fax

Practice location:
  • Phone: 248-377-0600
  • Fax: 248-377-0606
Mailing address:
  • Phone: 248-377-0600
  • Fax: 248-377-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704195563
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: