Healthcare Provider Details

I. General information

NPI: 1568631976
Provider Name (Legal Business Name): MICHELLE MILETIC MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N OLD WOODWARD AVE SUITE #201
BIRMINGHAM MI
48009-3855
US

IV. Provider business mailing address

620 N OLD WOODWARD AVE SUITE #201
BIRMINGHAM MI
48009-3855
US

V. Phone/Fax

Practice location:
  • Phone: 248-417-9521
  • Fax: 248-593-8542
Mailing address:
  • Phone: 248-417-9521
  • Fax: 248-593-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number6801075003
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: