Provider Demographics
NPI:1831362425
Name:MITRY, MICHAEL SAAD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SAAD
Last Name:MITRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 WAKEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5358
Mailing Address - Country:US
Mailing Address - Phone:248-722-6736
Mailing Address - Fax:
Practice Address - Street 1:3661 WAKEFIELD DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5358
Practice Address - Country:US
Practice Address - Phone:248-722-6736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090619208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery