Healthcare Provider Details

I. General information

NPI: 1316757446
Provider Name (Legal Business Name): MICHIGAN HEALTHCARE PROFESSIONALS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 MASON ST
DEARBORN MI
48124-2841
US

IV. Provider business mailing address

29992 NORTHWESTERN HWY STE C
FARMINGTON HILLS MI
48334-3292
US

V. Phone/Fax

Practice location:
  • Phone: 313-572-7771
  • Fax: 313-572-7484
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KRISTIE GRIMMETT
Title or Position: CREDENTIALING SPECIALIST
Credential: ADMIN
Phone: 248-780-6615