Provider Demographics
NPI:1073551149
Name:WEST, MIGUEL S (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:S
Last Name:WEST
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 1:22 HARTFORD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1844
Mailing Address - Country:US
Mailing Address - Phone:207-532-7936
Mailing Address - Fax:
Practice Address - Street 1:22 HARTFORD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1844
Practice Address - Country:US
Practice Address - Phone:207-532-7936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD21343208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H228210OtherBCBSM/BCN
MI700H228210OtherBCBSM/BCN