Healthcare Provider Details

I. General information

NPI: 1316734163
Provider Name (Legal Business Name): VALERIE L MACGILLIS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 HAMLIN BLVD
INKSTER MI
48141-2206
US

IV. Provider business mailing address

37450 SCHOOLCRAFT RD STE 110
LIVONIA MI
48150-1000
US

V. Phone/Fax

Practice location:
  • Phone: 313-561-5100
  • Fax:
Mailing address:
  • Phone: 734-744-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: