Provider Demographics
NPI:1891911095
Name:CEOUX, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CEOUX
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 1:19111 W 10 MILE RD
Mailing Address - Street 2:SUIT 216A
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2417
Mailing Address - Country:US
Mailing Address - Phone:248-355-4508
Mailing Address - Fax:248-355-4509
Practice Address - Street 1:19111 W 10 MILE RD
Practice Address - Street 2:SUIT 216A
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2417
Practice Address - Country:US
Practice Address - Phone:248-355-4508
Practice Address - Fax:248-355-4509
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2429907332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies