Provider Demographics
NPI:1952392813
Name:GREENLEY, MICHAEL Y (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:Y
Last Name:GREENLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29990 NORTHWESTERN HWY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3225
Mailing Address - Country:US
Mailing Address - Phone:248-538-6463
Mailing Address - Fax:248-538-6470
Practice Address - Street 1:29990 NORTHWESTERN HWY
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3225
Practice Address - Country:US
Practice Address - Phone:248-538-6463
Practice Address - Fax:248-538-6470
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045964207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4355120Medicaid
MIOP26660Medicare ID - Type Unspecified
0630734Medicare ID - Type Unspecified
MI4355120Medicaid