Healthcare Provider Details

I. General information

NPI: 1013782127
Provider Name (Legal Business Name): BMCNH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 COOLIDGE HWY
BERKLEY MI
48072-1635
US

IV. Provider business mailing address

3345 COOLIDGE HWY
BERKLEY MI
48072-1635
US

V. Phone/Fax

Practice location:
  • Phone: 248-544-7110
  • Fax: 248-544-7112
Mailing address:
  • Phone: 248-544-7110
  • Fax: 248-544-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VIAN MISHO
Title or Position: PRESIDENT
Credential: MD
Phone: 586-354-1851