Organization
ENVISION MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WAYNE DO (MANAGING PARTNER)
(248) 348-8700
Entity
Organization
Contact information
Practice address
422 N CENTER ST, SUITE B, NORTHVILLE, MI 48167-1224
(248) 449-7156
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
—
—
213ES0131X
Foot Surgery Podiatrist
Primary
—
—
Other
Enumeration date
04/26/2010
Last updated
02/23/2021
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