Healthcare Provider Details

I. General information

NPI: 1912086281
Provider Name (Legal Business Name): MIKE BAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5161 CARDINAL PARK DRIVE
SAGINAW MI
48604-9435
US

IV. Provider business mailing address

PO BOX 5649
SAGINAW MI
48603-0649
US

V. Phone/Fax

Practice location:
  • Phone: 989-797-2400
  • Fax: 989-249-1035
Mailing address:
  • Phone: 989-797-2400
  • Fax: 989-249-1035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License NumberMB000027
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: