Healthcare Provider Details

I. General information

NPI: 1164388187
Provider Name (Legal Business Name): MITZI DEBEER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19110 MAIN ST
SOUTHGATE MI
48195-3539
US

IV. Provider business mailing address

19110 MAIN ST
SOUTHGATE MI
48195-3539
US

V. Phone/Fax

Practice location:
  • Phone: 502-802-9248
  • Fax: 517-938-5948
Mailing address:
  • Phone: 502-802-9248
  • Fax: 517-938-5948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: