Provider Demographics
NPI:1003860651
Name:VEALE, MICHAEL R (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:VEALE
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 1:1711 S STEPHENSON AVE
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3648
Mailing Address - Country:US
Mailing Address - Phone:906-779-9870
Mailing Address - Fax:
Practice Address - Street 1:1711 S STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3639
Practice Address - Country:US
Practice Address - Phone:906-779-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074078207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2002210652OtherBLUE CROSS MICHIGAN
WI34670500Medicaid
MI982391045173OtherPREFERRED ONE
MI104758348Medicaid
MI0B26002080Medicare PIN
MII39917Medicare UPIN