1447020870 NPI number — DR. MIKHAYLA MICHIGAN APN

Table of content: DR. MIKHAYLA MICHIGAN APN (NPI 1447020870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447020870 NPI number — DR. MIKHAYLA MICHIGAN APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHIGAN
Provider First Name:
MIKHAYLA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
APN
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:
1447020870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 HIGH MEADOWS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MULLICA HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08062-9461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-254-7754
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 W CUTHBERT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HADDON TWP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08108-3642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-946-5180
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2024

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: 363LF0000X , with the licence number:  26NJ14984100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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