Provider Demographics
NPI:1811589708
Name:MIKHAEIL, MERVAT
Entity Type:Individual
Prefix:
First Name:MERVAT
Middle Name:
Last Name:MIKHAEIL
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 1:25861 LAHSER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-5880
Mailing Address - Country:US
Mailing Address - Phone:248-948-8800
Mailing Address - Fax:248-750-0691
Practice Address - Street 1:25861 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5880
Practice Address - Country:US
Practice Address - Phone:248-948-8800
Practice Address - Fax:248-750-0691
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI20120090417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist