Organization
ENVISION MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WAYNE DO (MANAGING MEMBER)
(248) 348-8700
Entity
Organization
Contact information
Practice address
12660 TEN MILE RD, SOUTH LYON, MI 48178-9141
(248) 348-1131
Mailing address
27275 HAGGERTY RD STE 500, NOVI, MI 48377-3635
(248) 741-6901
(248) 721-8203
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
213EP1101X
Primary Podiatric Medicine Podiatrist
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
09/29/2010
Last updated
02/23/2021
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