Healthcare Provider Details

I. General information

NPI: 1275448045
Provider Name (Legal Business Name): MICHELLE RENAUD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10544 LASALLE BLVD
HUNTINGTON WOODS MI
48070-1164
US

IV. Provider business mailing address

1401 W FORT ST UNIT 442451
DETROIT MI
48244-3599
US

V. Phone/Fax

Practice location:
  • Phone: 313-715-7709
  • Fax:
Mailing address:
  • Phone: 313-715-7709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: