Provider Demographics
NPI:1316467319
Name:ENLIGHTENED MEDICAL HOME VISIT PLLC
Entity type:Organization
Organization Name:ENLIGHTENED MEDICAL HOME VISIT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEIUTTENUN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-281-6469
Mailing Address - Street 1:20755 GREENFIELD RD STE 803
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5410
Mailing Address - Country:US
Mailing Address - Phone:248-281-6469
Mailing Address - Fax:947-282-6991
Practice Address - Street 1:20755 GREENFIELD RD
Practice Address - Street 2:SUITE 803
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-281-6469
Practice Address - Fax:947-282-6991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicaid