Healthcare Provider Details

I. General information

NPI: 1316855851
Provider Name (Legal Business Name): SELECTIVE MEDICAL OF MICHIGAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23350 GREENFIELD RD STE 200
OAK PARK MI
48237-2496
US

IV. Provider business mailing address

23350 GREENFIELD RD STE 200
OAK PARK MI
48237-2496
US

V. Phone/Fax

Practice location:
  • Phone: 248-544-3600
  • Fax: 248-313-9808
Mailing address:
  • Phone:
  • Fax: 248-313-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. GRACE W PATTERSON
Title or Position: CEO
Credential: MD
Phone: 248-544-3600