Provider Demographics
NPI:1033278395
Name:MICHELS, LORELEI A (DO)
Entity Type:Individual
Prefix:DR
First Name:LORELEI
Middle Name:A
Last Name:MICHELS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-0541
Mailing Address - Country:US
Mailing Address - Phone:518-763-3312
Mailing Address - Fax:518-489-4040
Practice Address - Street 1:638 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1830
Practice Address - Country:US
Practice Address - Phone:518-763-3312
Practice Address - Fax:518-489-4040
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02834619Medicaid
NYJ400006242Medicare PIN
NYP00765856Medicare PIN