Healthcare Provider Details

I. General information

NPI: 1154364230
Provider Name (Legal Business Name): ANNE MARIE MICHON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 W 13 MILE RD STE N300
ROYAL OAK MI
48073-6710
US

IV. Provider business mailing address

26901 BEAUMONT BLVD
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-3302
  • Fax: 248-551-7373
Mailing address:
  • Phone: 248-577-3313
  • Fax: 248-577-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704176675
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704176675
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: