Individual
DR. MIRA GRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
44428 WOODWARD AVENUE SUITE 102, PONTIAC, MI 48341-5009
(734) 712-8700
(734) 622-5017
Mailing address
44428 WOODWARD AVE STE 102, PONTIAC, MI 48341-5009
(562) 896-8786
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
4301507706
MI
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
4301507706
MI
Other
Enumeration date
06/22/2011
Last updated
04/03/2026
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