Healthcare Provider Details

I. General information

NPI: 1629932900
Provider Name (Legal Business Name): ARLY MICHELLE VILLARREAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25650 OUTER DR
LINCOLN PARK MI
48146-2096
US

IV. Provider business mailing address

4700 SCHAEFER RD
DEARBORN MI
48126-3655
US

V. Phone/Fax

Practice location:
  • Phone: 313-561-5100
  • Fax: 313-383-6092
Mailing address:
  • Phone: 313-561-5100
  • Fax: 313-945-0875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: