Healthcare Provider Details

I. General information

NPI: 1245688514
Provider Name (Legal Business Name): MICHELLE ANDRINE LOUBERT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 TEMPLE ST
MASON MI
48854-1851
US

IV. Provider business mailing address

230 TEMPLE ST
MASON MI
48854-1851
US

V. Phone/Fax

Practice location:
  • Phone: 517-676-9066
  • Fax:
Mailing address:
  • Phone: 517-676-9066
  • Fax: 517-676-3505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101022229
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: