Healthcare Provider Details

I. General information

NPI: 1053795252
Provider Name (Legal Business Name): KAREN RENEE MICHAUD AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN RENEE RILEY AU.D.

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 44TH ST SW
WYOMING MI
49509
US

IV. Provider business mailing address

1555 44TH ST SW
WYOMING MI
49509
US

V. Phone/Fax

Practice location:
  • Phone: 616-249-8000
  • Fax: 616-249-8088
Mailing address:
  • Phone: 616-249-8000
  • Fax: 616-249-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000711
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number16010000711
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: