Basic Information
| Provider Information | |||||||||
| NPI: | 1285298083 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | MIKKI-ANN | ||||||||
| MiddleName: | SIMONE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1540 E HOSPITAL DRIVE, SPC 4254 | ||||||||
| Address2: | 8-621 C&W MOTT HOSPITAL | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481094254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347634109 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1540 E HOSPITAL DRIVE, SPC 4254 | ||||||||
| Address2: | 8-621 C&W MOTT HOSPITAL | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481094254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347634109 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2019 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | 4301506286 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.