Provider Demographics
NPI:1144815093
Name:MICHIELUTTI, PAMELA SUSAN (MSA-QUIDP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUSAN
Last Name:MICHIELUTTI
Suffix:
Gender:F
Credentials:MSA-QUIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-4511
Mailing Address - Country:US
Mailing Address - Phone:586-764-1071
Mailing Address - Fax:586-469-7925
Practice Address - Street 1:6555 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48312-4511
Practice Address - Country:US
Practice Address - Phone:586-764-1071
Practice Address - Fax:586-469-7925
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator