MEDICARE: MICHELLE KAY ATIE PHARM.D.

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
1	183500000X	Pharmacist	5302032644	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5302032644	OTHER	MI	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1497878458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE KAY ATIE PHARM.D.

Provider Business Mailing Address
First Line	:	1001 WELCH RD STE 101
Second Line	:
City	:	COMMERCE TWP
State	:	MI
Zip	:	48390-2864
Country	:	US
Telephone Number	:	248-787-8858
Fax Number	:	248-859-2832

Provider Business Practice Location Address
First Line	:	1001 WELCH RD STE 101
Second Line	:
City	:	COMMERCE TWP
State	:	MI
Zip	:	48390-2864
Country	:	US
Telephone Number	:	248-859-2804
Fax Number	:	248-859-2832

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	10/26/2019

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