Provider Demographics
NPI:1093850059
Name:MICHALAKES, LAUREN G (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:G
Last Name:MICHALAKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:901 WASHINGTON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2737
Mailing Address - Country:US
Mailing Address - Phone:207-771-4770
Mailing Address - Fax:207-775-5530
Practice Address - Street 1:901 WASHINGTON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2737
Practice Address - Country:US
Practice Address - Phone:207-771-4770
Practice Address - Fax:207-775-5530
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME015213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000954901Medicare PIN
E15537Medicare UPIN
M52744Medicare ID - Type Unspecified