Provider Demographics
NPI:1699155366
Name:MISHULIN, ALEKSEY (MD)
Entity type:Individual
Prefix:
First Name:ALEKSEY
Middle Name:
Last Name:MISHULIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:MISHULIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1750 S TELEGRAPH STE 205
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302
Mailing Address - Country:US
Mailing Address - Phone:248-333-2900
Mailing Address - Fax:248-333-3539
Practice Address - Street 1:5300 GATEWAY CTR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3930
Practice Address - Country:US
Practice Address - Phone:810-720-9111
Practice Address - Fax:810-720-9119
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301107762207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty