Healthcare Provider Details

I. General information

NPI: 1447184635
Provider Name (Legal Business Name): M MEDICAL MI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 CONNER ST
DETROIT MI
48213-3405
US

IV. Provider business mailing address

6 E EAGER ST
BALTIMORE MD
21202-2506
US

V. Phone/Fax

Practice location:
  • Phone: 313-571-5555
  • Fax:
Mailing address:
  • Phone: 410-870-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: KRYSTLE D BROWN
Title or Position: BILLING MANAGER
Credential:
Phone: 410-800-6251