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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