Provider Demographics
NPI:1841308996
Name:MISHULIN, SVETLANA M (MD)
Entity type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:M
Last Name:MISHULIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3250 W BIG BEAVER RD STE 144
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-2907
Mailing Address - Country:US
Mailing Address - Phone:248-637-7100
Mailing Address - Fax:248-637-7175
Practice Address - Street 1:3250 W BIG BEAVER RD STE 144
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-2907
Practice Address - Country:US
Practice Address - Phone:248-637-7100
Practice Address - Fax:248-637-7175
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068674207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISM068674OtherBLUE SHIELD TRUST PPO
MI990014832OtherRR MEDICARE
MIG98045OtherSELECT CARE
MIP103256OtherBLUE CARE NETWORK
MIM77020007Medicare ID - Type Unspecified