Healthcare Provider Details

I. General information

NPI: 1235661703
Provider Name (Legal Business Name): ALISSA DIMICHELE D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TOWNSHIP MI
48038-3504
US

IV. Provider business mailing address

15855 19 MILE RD
CLINTON TOWNSHIP MI
48038-3504
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-2950
  • Fax:
Mailing address:
  • Phone: 586-263-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101024924
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: