Healthcare Provider Details

I. General information

NPI: 1477240125
Provider Name (Legal Business Name): MIKAYLA ANNMARIE GREEN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 HEDGEWOOD DR
MIDLAND MI
48640-1930
US

IV. Provider business mailing address

4911 HEDGEWOOD DR
MIDLAND MI
48640-1930
US

V. Phone/Fax

Practice location:
  • Phone: 989-631-8200
  • Fax: 989-631-5901
Mailing address:
  • Phone: 989-631-8200
  • Fax: 989-631-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901400602
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: