1821044553 NPI number — DR. GREGORY A MICHAELS MD

Table of content: DR. GREGORY A MICHAELS MD (NPI 1821044553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821044553 NPI number — DR. GREGORY A MICHAELS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHAELS
Provider First Name:
GREGORY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1821044553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13131 CORBEL CIR
Provider Second Line Business Mailing Address:
#312
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33907-6833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-267-2030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 BARKLEY CIR
Provider Second Line Business Practice Location Address:
STE. 100 & 101
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33907-4514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-938-3500
Provider Business Practice Location Address Fax Number:
239-278-0055
Provider Enumeration Date:
05/25/2006

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: 2085R0202X , with the licence number:  ME82942 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: G61922 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: ME 82942 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: G61922 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 264701000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5773317 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00318896 . This is a "RR MEDICARE FRL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 226258 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: ME82942 . This is a "FL WC CERTIFICATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: O6452 . This is a "BCBSFL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 264701000 . 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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