Healthcare Provider Details

I. General information

NPI: 1427964006
Provider Name (Legal Business Name): MITKO ANDREEVSKI RVT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22101 MOROSS RD
DETROIT MI
48236-2148
US

IV. Provider business mailing address

49262 BINGHAM LN
MACOMB MI
48044-1549
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-4000
  • Fax:
Mailing address:
  • Phone: 586-808-8827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number196897
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: