Provider Demographics
NPI:1013183052
Name:MICHAEL MAHON D O PC
Entity Type:Organization
Organization Name:MICHAEL MAHON D O PC
Other - Org Name:MIDDLEBELT DERMATOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAHON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-477-7022
Mailing Address - Street 1:21141 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5516
Mailing Address - Country:US
Mailing Address - Phone:248-477-7022
Mailing Address - Fax:248-477-9370
Practice Address - Street 1:21141 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5516
Practice Address - Country:US
Practice Address - Phone:248-477-7022
Practice Address - Fax:248-477-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006141207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU37599Medicare UPIN