Individual
MIKELL NOVELLA WHACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
32100 TELEGRAPH RD, SUITE 205, BINGHAM FRAMS, MI 48025
(248) 712-4266
Mailing address
17344 WISCONSIN ST, DETROIT, MI 48221-2502
(313) 753-8629
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
—
—
Other
Enumeration date
05/08/2018
Last updated
05/08/2018
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