Provider Demographics
NPI:1164489316
Name:MAKULSKI, MIRANDA RHONDA (DO)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:RHONDA
Last Name:MAKULSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:RHONDA
Other - Last Name:ATKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT 272801
Mailing Address - Street 2:PO BOX 67000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2728
Mailing Address - Country:US
Mailing Address - Phone:517-629-8311
Mailing Address - Fax:517-629-7952
Practice Address - Street 1:2845 CAPITAL AVE SW STE 302
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4187
Practice Address - Country:US
Practice Address - Phone:269-979-6333
Practice Address - Fax:269-979-6333
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4762556Medicaid
MII37959Medicare UPIN
MI4762556Medicaid