Change of Name or Address/Duplicate License Request for Health Licensees

To change your name and/or address for one of the following professions please visit www.michigan.gov/miplus:

 

Behavior Analyst/Assistant Behavior Analyst

Dentists and dental related professions

Medicine

Midwifery      

Optometry

Osteopathic Medicine

Pharmacy and pharmacy related professions

Podiatry

Physician’s Assistant

Veterinary Medicine related veterinary professions

 

You will have the option of paying for a new license to be issued with updated information as part of the process.

 

For all other health professions you must submit a request to change your name in writing.  To change your address, for a profession not listed above, you must either submit in writing or via the Internet at www.michigan.gov/elicense.   If you require a new license to be issued with the new information you can request and pay for a duplicate license with a credit card. A new license is not issued automatically.

 

You can also complete the Data Change/Duplicate License Request Form

 

Fax to 517-335-2044 or email to BPLHelp@michigan.gov  (only if new license is not being requested) or

Mail the form to LARA/BPL/Licensing Division, PO Box 30670, Lansing MI 48909.

Include $10 fee if new license is being requested.