Healthcare Provider Details

I. General information

NPI: 1881158749
Provider Name (Legal Business Name): DREW STEPHEN MILES FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31157 WOODWARD AVE
ROYAL OAK MI
48073-0996
US

IV. Provider business mailing address

29992 NORTHWESTERN HWY STE C
FARMINGTON HILLS MI
48334-3292
US

V. Phone/Fax

Practice location:
  • Phone: 248-336-0123
  • Fax: 248-268-1523
Mailing address:
  • Phone: 248-851-1423
  • Fax: 248-851-5319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704306900
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF11180493
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: