Healthcare Provider Details

I. General information

NPI: 1487053575
Provider Name (Legal Business Name): DOUGLAS MICHAEL PIERNICK II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20030 MACK AVE
GROSSE POINTE WOODS MI
48236-2323
US

IV. Provider business mailing address

20030 MACK AVE
GROSSE POINTE WOODS MI
48236-2323
US

V. Phone/Fax

Practice location:
  • Phone: 313-884-3380
  • Fax:
Mailing address:
  • Phone: 313-203-8678
  • Fax: 313-884-9756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number4301105765
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: