Healthcare Provider Details

I. General information

NPI: 1821439779
Provider Name (Legal Business Name): ADAM MICHAEL MACIVER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 STEWART RD
MONROE MI
48162-4393
US

IV. Provider business mailing address

321 STEWART RD
MONROE MI
48162-4393
US

V. Phone/Fax

Practice location:
  • Phone: 734-243-5020
  • Fax: 734-457-1970
Mailing address:
  • Phone: 734-243-5020
  • Fax: 734-457-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704276022
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: