1881683654 NPI number — BERL A MICHEL DC

Table of content: BERL A MICHEL DC (NPI 1881683654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881683654 NPI number — BERL A MICHEL DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHEL
Provider First Name:
BERL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881683654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9121 N MILITARY TRL
Provider Second Line Business Mailing Address:
STE 208
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33410-5984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-627-2747
Provider Business Mailing Address Fax Number:
561-691-2098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9121 N MILITARY TRL
Provider Second Line Business Practice Location Address:
STE 208
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33410-5984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-627-2747
Provider Business Practice Location Address Fax Number:
561-691-2098
Provider Enumeration Date:
10/14/2005

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: 111N00000X , with the licence number:  CH0005855 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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