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General NPI Number Information
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NPI Number | 1861710493
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Entity Type | Organization
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Legal Business Name | HEALTHY AFFAIR, PLLC
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 2600 LONE PINE RD
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-3642
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Country | US
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Telephone | 248-885-4162
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 LONE PINE RD
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-3642
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Country | US
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Telephone | 248-885-4162
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANUJ MITTAL
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Credential | M.D.
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Telephone | 248-885-4162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301077841
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License Number State | MI
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