Healthcare Provider Details

I. General information

NPI: 1083172266
Provider Name (Legal Business Name): RETINA INSTITUTE OF MICHIGAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31500 TELEGRAPH RD STE 5
BINGHAM FARMS MI
48025-4329
US

IV. Provider business mailing address

31500 TELEGRAPH RD STE 5
BINGHAM FARMS MI
48025-4329
US

V. Phone/Fax

Practice location:
  • Phone: 248-621-0200
  • Fax:
Mailing address:
  • Phone: 248-621-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANU SINGLA PATEL
Title or Position: OWNER
Credential: MD
Phone: 248-621-0200