Healthcare Provider Details

I. General information

NPI: 1770510232
Provider Name (Legal Business Name): MICHELLE M. HAGES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 AUDUBON RD
GROSSE POINTE PARK MI
48230-1153
US

IV. Provider business mailing address

1395 AUDUBON RD
GROSSE POINTE PARK MI
48230-1153
US

V. Phone/Fax

Practice location:
  • Phone: 313-882-0398
  • Fax: 313-882-0398
Mailing address:
  • Phone: 313-882-0398
  • Fax: 313-882-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberL801142
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: