Healthcare Provider Details

I. General information

NPI: 1831956986
Provider Name (Legal Business Name): MICHIGAN HEALTHCARE PROFESSIONALS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29992 NORTHWESTERN HWY
FARMINGTON HILLS MI
48334-3292
US

IV. Provider business mailing address

29992 NORTHWESTERN HWY
FARMINGTON HILLS MI
48334-3292
US

V. Phone/Fax

Practice location:
  • Phone: 248-851-1430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNDA ASSUNTA GLASSER
Title or Position: CPA, CGMA
Credential:
Phone: 248-851-3300