Provider Demographics
NPI:1962220053
Name:MICHIGAN MOBILE MEDICINE, PLLC
Entity type:Organization
Organization Name:MICHIGAN MOBILE MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-481-2100
Mailing Address - Street 1:43700 WOODWARD AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5061
Mailing Address - Country:US
Mailing Address - Phone:248-481-2100
Mailing Address - Fax:248-359-8750
Practice Address - Street 1:43700 WOODWARD AVE STE 207
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5061
Practice Address - Country:US
Practice Address - Phone:248-481-2100
Practice Address - Fax:248-359-8750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty