ENVISION MEDICAL GROUP PLLC NPI 1003125774

NPI Information

  • NPI: 1003125774
  • Provider Name: ENVISION MEDICAL GROUP PLLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 23D0368314
  • Address: 12660 TEN MILE RD
    SOUTH LYON, MI
    ZIP 48178
  • Phone: (248) 348-1131

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NPI Details

ENVISION MEDICAL GROUP PLLC is a family medicine in South Lyon, MI. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. ENVISION MEDICAL GROUP PLLC NPI is 1003125774. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

12660 TEN MILE RD
SOUTH LYON, MI
ZIP 48178-141
Phone: (248) 348-1131

The provider's authorized official is Michael Wayne .
The authorized official title is Managing Member and has the following contact phone number (248) 348-8700.

The CLIA number assigned to this NPI record is 23D0368314 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/29/2010 and was last updated on 2/23/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RC0000XInternal MedicineCardiovascular DiseaseNo
22085R0202XRadiologyDiagnostic RadiologyNo
3213EP1101XPodiatristPrimary Podiatric MedicineNo
4363A00000XPhysician AssistantNo
5207Q00000XFamily MedicineYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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