Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Michigan Medical Mall

Organization Family Medicine Physician · NPI 1194133686

Michigan Medical Mall provides Family Medicine Physician services in Detroit, Michigan. Registered with an NPI since 2014.

In the registry since
2014

Practice location Address checks out

17350 Livernois Ave
Detroit, MI 48221-2759 Not confirmed with CMS for 12 years — call before visiting
Phone: (256) 262-9310
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1194133686
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Schara Davis — Owner/Incorporator · (256) 262-9310
NPI enumeratedJuly 28, 2014
Last updated in NPPESJuly 28, 2014
Mailing address17350 Livernois Ave, Detroit, MI 48221-2759

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