Healthcare Provider Details
I. General information
NPI: 1548085178
Provider Name (Legal Business Name): MIVISION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5310 HAMPTON PL STE 1
SAGINAW MI
48604-8202
US
IV. Provider business mailing address
5310 HAMPTON PL STE 1
SAGINAW MI
48604-8202
US
V. Phone/Fax
- Phone: 989-321-2655
- Fax:
- Phone: 989-321-2655
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207W00000X |
| Taxonomy | Ophthalmology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MELANIE
LYNN
MIHLSTIN
Title or Position: OWNER
Credential: MD
Phone: 810-441-2324