Provider Demographics
NPI:1003834805
Name:MICHAS, GEORGE ARISTOTLE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ARISTOTLE
Last Name:MICHAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 SHADOW LN STE B
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1282
Mailing Address - Country:US
Mailing Address - Phone:850-862-3141
Mailing Address - Fax:850-862-7732
Practice Address - Street 1:814 SHADOW LN STE B
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-862-3141
Practice Address - Fax:850-862-7732
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46057OtherBLUE CROSS BLUE SHIELD
FL46057ZMedicare ID - Type Unspecified
D54928Medicare UPIN