Healthcare Provider Details

I. General information

NPI: 1225622525
Provider Name (Legal Business Name): FAITH MARIA MIEGOC PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 WALTON BLVD STE 216
ROCHESTER HILLS MI
48307-6917
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 248-710-3023
  • Fax:
Mailing address:
  • Phone: 947-522-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010922
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: