Healthcare Provider Details

I. General information

NPI: 1487697603
Provider Name (Legal Business Name): ANNE B MICK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R ST SUITE 510
DETROIT MI
48201-2020
US

IV. Provider business mailing address

4455 TOWN CENTER PKWY
FLINT MI
48532-3425
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-7777
  • Fax: 313-993-2563
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704216332
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: