Provider Demographics
NPI:1083654560
Name:RIVERA, MICHELLE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:4201 ST. ANTOINE - UHC 5D #226
Mailing Address - Street 2:UNIVERSITY PEDIATRICIANS
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-745-4405
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:3901 BEAUBIEN ER DEPT - GROUND FL
Practice Address - Street 2:CHILDRENS HOSPITAL MI EMERGENCY MED
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5260
Practice Address - Fax:313-966-0665
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2017-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301064284208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine