Envision Medical Group Pllc

NPI #1003125774 in South Lyon, Michigan

Provider Information

NPI Number: 1003125774
Entity Type: Organization
Organization Name: Envision Medical Group Pllc
Primary Specialty: Family Medicine
Enumeration Date: Sep 29, 2010
Last Updated: Feb 23, 2021

Practice Location

Address: 12660 TEN MILE RD
City: South Lyon
State: Michigan
ZIP Code: 48178-9141
Phone: (248) 348-1131

Authorized Official

Name: MICHAEL WAYNE, DO
Title: MANAGING MEMBER
Phone: (248) 348-8700

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine - Cardiovascular Disease — Cardiovascular Disease	207RC0000X
Radiology - Diagnostic Radiology — Diagnostic Radiology	2085R0202X
Podiatrist - Primary Podiatric Medicine — Primary Podiatric Medicine	213EP1101X
Physician Assistant	363A00000X
Family Medicine	207Q00000X	Primary

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