Healthcare Provider Details

I. General information

NPI: 1982526752
Provider Name (Legal Business Name): MICHAEL MAKLED BSN-RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18820 NEGAUNEE
REDFORD MI
48240-2027
US

IV. Provider business mailing address

18820 NEGAUNEE
REDFORD MI
48240-2027
US

V. Phone/Fax

Practice location:
  • Phone: 313-247-5127
  • Fax:
Mailing address:
  • Phone: 313-247-5127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704356382
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: