MEDICARE: ALEKSEY MISHULIN MD

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	207W00000X	Ophthalmology Physician	4301107762	MI

General Provider Information

NPI Number	:	1699155366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEKSEY MISHULIN MD

Provider Business Mailing Address
First Line	:	1750 S TELEGRAPH STE 205
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302
Country	:	US
Telephone Number	:	248-333-2900
Fax Number	:	248-333-3539

Provider Business Practice Location Address
First Line	:	5300 GATEWAY CTR
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-3930
Country	:	US
Telephone Number	:	810-720-9111
Fax Number	:	810-720-9119

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

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	12/13/2022

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