Organization
MIDWEST DETOX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONOVAN MISKE (EXECUTIVE DIRECTOR)
(313) 444-0167
Entity
Organization
Contact information
Practice address
31153 PLYMOUTH RD STE 105, LIVONIA, MI 48150-2134
(231) 409-0606
Mailing address
31153 PLYMOUTH RD STE 105, LIVONIA, MI 48150-2134
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/26/2022
Last updated
01/26/2022
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