Healthcare Provider Details

I. General information

NPI: 1093672503
Provider Name (Legal Business Name): MYTEZ D MEANS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9138 ELBERT DR
ROMULUS MI
48174
US

IV. Provider business mailing address

9138 ELBERT DR
ROMULUS MI
48174
US

V. Phone/Fax

Practice location:
  • Phone: 313-728-3777
  • Fax: 313-728-3777
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: