Healthcare Provider Details

I. General information

NPI: 1780144709
Provider Name (Legal Business Name): MICHAEL PHAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20905 GREENFIELD RD
SOUTHFIELD MI
48075-5360
US

IV. Provider business mailing address

26222 TELEGRAPH RD
SOUTHFIELD MI
48033-5318
US

V. Phone/Fax

Practice location:
  • Phone: 248-569-0296
  • Fax:
Mailing address:
  • Phone: 248-827-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number5101026323
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number5101026323
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: