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NPI Code Detail

MEDICARE: ANGELA MICHAEL

MEDICARE: ANGELA MICHAEL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health AgencyNV20131611035NV

General Provider Information

NPI Number : 1295154508
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA MICHAEL
Provider Business Mailing Address
First Line : 695 SHEPARDBUSH ST
Second Line :
City : BIRMINGHAM
State : MI
Zip : 48009-5551
Country : US
Telephone Number : 248-925-2454
Fax Number :
Provider Business Practice Location Address
First Line : 7455 ARROYO CROSSING PKWY STE 220
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-4088
Country : US
Telephone Number : 702-751-2797
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2014
Last Update Date : 04/15/2014

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