1538142476 NPI number — DR. LINDA SUZANNE MICHAELS PHD

Table of content: DR. LINDA SUZANNE MICHAELS PHD (NPI 1538142476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538142476 NPI number — DR. LINDA SUZANNE MICHAELS PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHAELS
Provider First Name:
LINDA
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
SUZI
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1538142476
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
679 PLATT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43605-1707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-697-9797
Provider Business Mailing Address Fax Number:
419-697-9754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
679 PLATT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43605-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-697-9797
Provider Business Practice Location Address Fax Number:
419-697-9754
Provider Enumeration Date:
11/23/2005

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: 103T00000X , with the licence number:  4766 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000280542 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0960241 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com