Healthcare Provider Details

I. General information

NPI: 1518214790
Provider Name (Legal Business Name): MICHAEL JAMES YARBROUGH MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9605 GRAND RIVER AVE
DETROIT MI
48204-2139
US

IV. Provider business mailing address

20220 WINTHROP ST
DETROIT MI
48235-1815
US

V. Phone/Fax

Practice location:
  • Phone: 313-834-5930
  • Fax: 313-834-4541
Mailing address:
  • Phone: 313-341-5842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: