Provider Demographics
NPI:1295405694
Name:ADAMS, MICHAELA M
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:M
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20186 ROGGE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3033
Mailing Address - Country:US
Mailing Address - Phone:586-244-2041
Mailing Address - Fax:
Practice Address - Street 1:700 E GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2526
Practice Address - Country:US
Practice Address - Phone:313-267-1622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist