Organization
ENVISION MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WAYNE MD (MANAGING MEMBER)
(248) 348-8700
Entity
Organization
Contact information
Practice address
422 N CENTER ST, NORTHVILLE, MI 48167-1224
(248) 348-1131
Mailing address
PO BOX 27420, BELFAST, ME 04915-2026
(405) 682-3303
(405) 384-6793
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/14/2010
Last updated
01/08/2021
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