Healthcare Provider Details

I. General information

NPI: 1144124447
Provider Name (Legal Business Name): CERMAK & SON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 OPAL DR
DEARBORN MI
48126-2918
US

IV. Provider business mailing address

10 OPAL DR
DEARBORN MI
48126-2918
US

V. Phone/Fax

Practice location:
  • Phone: 313-671-1044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHELLE CERMAK
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 313-671-1044