Provider Demographics
NPI:1851416929
Name:MICHELLE CALHOUN, D.O., P.C.
Entity Type:Organization
Organization Name:MICHELLE CALHOUN, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AQUARIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-967-3200
Mailing Address - Street 1:22100 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2550
Mailing Address - Country:US
Mailing Address - Phone:248-967-3200
Mailing Address - Fax:248-967-1387
Practice Address - Street 1:22100 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2550
Practice Address - Country:US
Practice Address - Phone:248-967-3200
Practice Address - Fax:248-967-1387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101012320OtherLICENSE NUMBER
MI56310495OtherBCBS PROVIDER NUMBER
MI56310495OtherBCBS PROVIDER NUMBER
MI56310495OtherBCBS PROVIDER NUMBER