Individual
TODD MIYAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109-5000
(734) 936-4280
Mailing address
PHR GROUP PROVIDER ENROLLMENT UNIT, 393 E WALNUT ST FL 3, PASADENA, CA 91188-0001
(877) 608-0044
(877) 514-0903
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A160834
CA
Other
Enumeration date
06/04/2015
Last updated
11/30/2021
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