Individual
DR. MICHELLE BONITA CALHOUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
27207 LAHSER RD, SUITE 250, SOUTHFIELD, MI 48034-2168
(248) 967-3200
(248) 967-1387
Mailing address
27207 LAHSER RD, SUITE 250, SOUTHFIELD, MI 48034-2168
(248) 967-3200
(248) 967-1387
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101012320
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4546506-11
—
MI
01
—
471738075
TAX ID
MI
01
—
5101012320
MEDICAL LICENSE
MI
01
—
56310495
BCBS PROVIDER NUMBER
MI
01
—
5633229
BCBSM PIN
MI
01
—
OP46640
GROUP PTAN
MI
01
—
P46640001
PROVIDER PTAN
MI
Enumeration date
11/21/2006
Last updated
06/23/2015
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