1386989390 NPI number — MICHELLE LOREN MICHAELS NP

Table of content: MICHELLE LOREN MICHAELS NP (NPI 1386989390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386989390 NPI number — MICHELLE LOREN MICHAELS NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHAELS
Provider First Name:
MICHELLE
Provider Middle Name:
LOREN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

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:
1386989390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 BUTTERFIELD RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-1069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-725-2730
Provider Business Mailing Address Fax Number:
844-205-5691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5550 FRIENDSHIP BLVD
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
CHEVY CHASE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20815-7256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-215-9250
Provider Business Practice Location Address Fax Number:
301-215-9251
Provider Enumeration Date:
12/02/2012

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: 363LA2100X , with the licence number:  R197768 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2100X , with the licence number: RN1015848 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 105412700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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