1003816646 NPI number — DR. LISA MICHAELS D.P.M.

Table of content: DR. LISA MICHAELS D.P.M. (NPI 1003816646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003816646 NPI number — DR. LISA MICHAELS D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHAELS
Provider First Name:
LISA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MICHAELS
Provider Other First Name:
ALIZA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.M.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1003816646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1593 MCDANIEL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19380-7039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-431-0200
Provider Business Mailing Address Fax Number:
610-431-9333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1593 MCDANIEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19380-7039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-431-0200
Provider Business Practice Location Address Fax Number:
610-431-9333
Provider Enumeration Date:
07/26/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  E10000173 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000034829 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000600450 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".