Provider Demographics
NPI:1194926758
Name:MICHOLDINGS, INC.
Entity type:Organization
Organization Name:MICHOLDINGS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IKECHUKWU
Authorized Official - Middle Name:C
Authorized Official - Last Name:ODUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-485-0355
Mailing Address - Street 1:2004 HOGBACK RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9738
Mailing Address - Country:US
Mailing Address - Phone:734-485-0355
Mailing Address - Fax:734-485-0355
Practice Address - Street 1:2004 HOGBACK RD
Practice Address - Street 2:SUITE 7
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9738
Practice Address - Country:US
Practice Address - Phone:734-485-0355
Practice Address - Fax:734-485-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9584840Medicaid