Organization
ENVISION MEDICAL GROUP PLLC
Active
Organization
ENVISION MEDICAL GROUP PLLC
Active
Other names
Envision Lab
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WAYNE DO (MANAGING MEMBER)
(248) 348-8700
Entity
Organization
Contact information
Practice address
17800 NEWBURGH RD, SUITE 103, LIVONIA, MI 48152-2700
(734) 464-9540
Mailing address
15100 MERCANTILE DR, DEARBORN, MI 48120-1223
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
03/15/2010
Last updated
02/01/2021
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