Healthcare Provider Details

I. General information

NPI: 1124095666
Provider Name (Legal Business Name): BAN MECHAEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19930 FARMINGTON RD SUITE A
LIVONIA MI
48152-1433
US

IV. Provider business mailing address

19930 FARMINGTON RD SUITE A
LIVONIA MI
48152
US

V. Phone/Fax

Practice location:
  • Phone: 248-476-6209
  • Fax: 248-476-6237
Mailing address:
  • Phone: 248-476-6209
  • Fax: 248-476-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberBM073200
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: