Healthcare Provider Details

I. General information

NPI: 1528551488
Provider Name (Legal Business Name): MICHAEL BAIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 03/03/2023
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4986 N ADAMS RD STE A
ROCHESTER MI
48306-5017
US

IV. Provider business mailing address

4986 N ADAMS RD
ROCHESTER MI
48306-5017
US

V. Phone/Fax

Practice location:
  • Phone: 248-475-4301
  • Fax: 248-475-4305
Mailing address:
  • Phone: 248-475-4301
  • Fax: 248-475-4305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number5101025207
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101024017
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: