MEDICARE: DR. MIEA MOON MA, PHD

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	103TC0700X	Clinical Psychologist	6301016960	MI
2	103T00000X	Psychologist	6301016960	MI

General Provider Information

NPI Number	:	1538671250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIEA MOON MA, PHD

Provider Business Mailing Address
First Line	:	2395 OAK VALLEY DR STE 100
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-9118
Country	:	US
Telephone Number	:	734-707-3770
Fax Number	:

Provider Business Practice Location Address
First Line	:	2395 OAK VALLEY DR STE 100
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-9118
Country	:	US
Telephone Number	:	734-707-3770
Fax Number	:

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

Provider Enumeration Date	:	11/03/2017
Last Update Date	:	04/27/2026

Similar Medicare Providers

1811563604 — MOON WELLNESS GROUP, PLLC
Practice Location Address:

2395 OAK VALLEY DR STE 100
ANN ARBOR, MI
48103-9118

Practice Phone: 734-681-0830
Practice Fax:

1851307805 — DR. LORI LICHTMAN PSYD
Practice Location Address:

2395 OAK VALLEY DR , SUITE 100
ANN ARBOR, MI
48103-9118

Practice Phone: 734-995-5181
Practice Fax: 734-995-9011

1730202599 — DR. PHILIP ANDREW CORNELL SARAGOZA M.D.
Practice Location Address:

2395 OAK VALLEY DR STE 100
ANN ARBOR, MI
48103-9118

Practice Phone: 734-995-5181
Practice Fax: 734-995-9011

1811103997 — GABRIELLE GRUBER LMSW
Practice Location Address:

2395 OAK VALLEY DR STE 100
ANN ARBOR, MI
48103-9118

Practice Phone: 734-645-8296
Practice Fax:

1417281072 — DR. REBECCA ELLEN OSTERHOUT PHD
Practice Location Address:

2395 OAK VALLEY DR , SUITE 100
ANN ARBOR, MI
48103-9118

Practice Phone: 607-725-6870
Practice Fax:

1609132943 — EMILY ABBENANTE-HONOLD
Practice Location Address:

2395 OAK VALLEY DR , SUITE 100
ANN ARBOR, MI
48103-9118

Practice Phone: 734-995-5181
Practice Fax: 734-995-9011

Directions to “ DR. MIEA MOON MA, PHD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.