Michigan Medical Mall

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MICHIGAN MEDICAL MALL

Practice address

17350 Livernois Ave
Detroit, MI 48221-2759

Phone

(256) 262-9310

NPI assigned

Jul 28, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Schara Davis

Title

Owner/Incorporator

Phone

(256) 262-9310

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406505600000",
    "number": "1194133686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17350 LIVERNOIS AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482212759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17350 LIVERNOIS AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482212759",
            "telephone_number": "256-262-9310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN MEDICAL MALL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-28",
        "last_updated": "2014-07-28",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SCHARA",
        "authorized_official_title_or_position": "OWNER/INCORPORATOR",
        "authorized_official_telephone_number": "256-262-9310"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michigan Health Center PC
• Michigan Home Help Services LLC
• Michigan Infection Specialists PLLC
• Michigan Institute for Prevention and Intervention
• Michigan Magical
• Michigan Medical Specialists PC
• Michigan Pain&Spine Clinic PLLC
• Michigan Pediatric Cardiovascular Surgeons PC
• Michigan Pediatric Surgery Associates P.C.
• Michigan Physical Therapy

• Family Medicine Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.