Provider Demographics
NPI:1043820178
Name:MICHELSON AXIAK, DORIAN R (NP-C)
Entity type:Individual
Prefix:
First Name:DORIAN
Middle Name:R
Last Name:MICHELSON AXIAK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 W BIG BEAVER RD STE 900
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4771
Mailing Address - Country:US
Mailing Address - Phone:248-629-2880
Mailing Address - Fax:
Practice Address - Street 1:888 W BIG BEAVER RD STE 900
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4771
Practice Address - Country:US
Practice Address - Phone:248-629-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704281432363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner