Organization
ENVISION MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WAYNE DO (MANAGING MEMBER)
(248) 741-6909
Entity
Organization
Contact information
Practice address
42931 7 MILE RD, NORTHVILLE, MI 48167-2277
(248) 348-8700
Mailing address
PO BOX 27420, BELFAST, ME 04915-2026
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
213EP1101X
Primary Podiatric Medicine Podiatrist
—
—
291U00000X
Clinical Medical Laboratory
23D0368331
MI
363A00000X
Physician Assistant
—
—
Other
Enumeration date
11/25/2009
Last updated
01/25/2021
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