1598356537 NPI number — MARILYN S MICHAEL MA, LLP

Table of content: MARILYN S MICHAEL MA, LLP (NPI 1598356537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598356537 NPI number — MARILYN S MICHAEL MA, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHAEL
Provider First Name:
MARILYN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598356537
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
904 FRANK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE ORION
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48362-1718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-977-2964
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27172 WOODWARD AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
ROYAL OAK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48067-0965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-546-0407
Provider Business Practice Location Address Fax Number:
866-422-3133
Provider Enumeration Date:
02/02/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
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Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  6361001241 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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