Provider Demographics
NPI:1710567235
Name:BAREA, MIKAYLA (MD)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:BAREA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-0688
Mailing Address - Fax:248-543-8120
Practice Address - Street 1:950 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1840
Practice Address - Country:US
Practice Address - Phone:248-543-8111
Practice Address - Fax:248-543-8120
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4351047659207Q00000X
MI4301511087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty