Healthcare Provider Details

I. General information

NPI: 1982098646
Provider Name (Legal Business Name): MICHIGAN HEALTHCARE PROFESSIONALS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32255 NORTHWESTERN HWY SUITE 50
FARMINGTON HILLS MI
48334-1566
US

IV. Provider business mailing address

29992 NORTHWESTERN HWY SUITE C
FARMINGTON HILLS MI
48334-3292
US

V. Phone/Fax

Practice location:
  • Phone: 248-945-0000
  • Fax: 248-419-3506
Mailing address:
  • Phone: 248-851-1430
  • Fax: 248-851-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHAELENE GOGOLIN
Title or Position: ASST SECRETARY OF CREDENTIALING
Credential:
Phone: 248-851-1430