Individual
DR. MIA MICHELENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1540 LAKE LANSING RD, STE 102, LANSING, MI 48912-3756
(517) 913-3810
(517) 913-3811
Mailing address
1775 DEMPSTER ST, RM E592B, PARK RIDGE, IL 60068-1143
(517) 913-3810
(517) 913-3811
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036149453
IL
207R00000X
Internal Medicine Physician
5101015690
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1022116
MCLAREN HEALTH PLAN-COMMERCIAL
MI
01
—
1153311825
BLUE CROSS BLUE SHIELD
MI
01
—
200000002785
PHP
MI
05
—
4849578
—
MI
01
—
7419836
AETNA
MI
01
—
M21440049
MEDICARE ADVANTAGE
MI
01
—
P00338685
RAILROAD MEDICARE
MI
Enumeration date
06/13/2006
Last updated
12/21/2021
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