Organization
ADVANCED HEALTHCARE FOR WOMEN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRA MICKELSON MD (PRESIDENT)
(248) 822-6200
Entity
Organization
Contact information
Practice address
1777 AXTELL, SUITE 102, TROY, MI 48084
(248) 822-6200
Mailing address
1777 AXTELL, SUITE 102, TROY, MI 48084
(248) 822-6200
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
IM043839
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160F318220
BCBS OF MICHIGAN
MI
Enumeration date
10/04/2006
Last updated
04/25/2014
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