Individual
MARY A MICELI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
422 N CENTER ST, NORTHVILLE, MI 48167-1224
(483) 481-1312
(248) 348-1170
Mailing address
422 N CENTER ST, NORTHVILLE, MI 48167-1224
(248) 348-1131
(248) 348-1170
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003648
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00083625
RAILROAD MEDICARE
MI
Enumeration date
07/31/2006
Last updated
03/07/2023
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