Healthcare Provider Details

I. General information

NPI: 1750291019
Provider Name (Legal Business Name): BTL MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19951 SCHOOLHOUSE CT
NORTHVILLE MI
48167-1939
US

IV. Provider business mailing address

19951 SCHOOLHOUSE CT
NORTHVILLE MI
48167-1939
US

V. Phone/Fax

Practice location:
  • Phone: 906-458-4855
  • Fax:
Mailing address:
  • Phone: 906-458-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TIA LAVELLE MILLS
Title or Position: NURSE PRACTITIONER
Credential: FNP
Phone: 906-458-4855