Provider Demographics
NPI:1811404312
Name:MICHELS, TRACEY MARIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:MARIE
Last Name:MICHELS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 S. TELEGRAPH
Mailing Address - Street 2:DEARBORN FAMILY CLINIC
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-565-6566
Mailing Address - Fax:313-561-5554
Practice Address - Street 1:3133 S. TELEGRAPH
Practice Address - Street 2:DEARBORN FAMILY CLINIC
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-565-6566
Practice Address - Fax:313-561-5554
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704220181363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty