=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568396752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M MEDICAL MI PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2026
-----------------------------------------------------
Last Update Date | 06/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5201 CONNER ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48213-3405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-571-5555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 E EAGER ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21202-2506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-870-9380
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | KRYSTLE D BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-800-6251
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------