Provider Demographics
NPI:1912188186
Name:EBMEYER, MICHELE
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:EBMEYER
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 1:3051 COMMERCE DR
Mailing Address - Street 2:STE 5
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3866
Mailing Address - Country:US
Mailing Address - Phone:810-385-4463
Mailing Address - Fax:810-385-4463
Practice Address - Street 1:3051 COMMERCE DR
Practice Address - Street 2:STE 5
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3866
Practice Address - Country:US
Practice Address - Phone:810-385-4463
Practice Address - Fax:810-385-4463
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care