Provider Demographics
NPI:1700255833
Name:MCDADE, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCDADE
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 1:32777 GRAND RIVER AVE
Mailing Address - Street 2:APARTMENT 109A
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3160
Mailing Address - Country:US
Mailing Address - Phone:248-443-6897
Mailing Address - Fax:
Practice Address - Street 1:32777 GRAND RIVER AVE
Practice Address - Street 2:APARTMENT 109A
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3160
Practice Address - Country:US
Practice Address - Phone:248-443-6897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other