Healthcare Provider Details

I. General information

NPI: 1346606126
Provider Name (Legal Business Name): MICHAEL PERKINS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 N OPDYKE RD
AUBURN HILLS MI
48326-2641
US

IV. Provider business mailing address

33900 HARPER AVE SUITE 104
CLINTON TOWNSHIP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 248-724-0864
  • Fax: 248-373-7443
Mailing address:
  • Phone: 586-416-9100
  • Fax: 586-416-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601000747
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: