Individual
COLLEEN LAROSE MIELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3031 W GRAND BLVD, DETROIT, MI 48202-3046
(313) 916-3121
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301061288
MI
2080A0000X
Pediatric Adolescent Medicine Physician
4301061288
MI
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
4301061288
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
325523710
—
MI
Enumeration date
07/19/2005
Last updated
11/03/2025
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