Provider Demographics
NPI:1114180494
Name:KEITH MICHL MD FACP
Entity Type:Organization
Organization Name:KEITH MICHL MD FACP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:W
Authorized Official - Last Name:MICHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-362-9031
Mailing Address - Street 1:7252 MAIN STREET
Mailing Address - Street 2:PO BOX 1431
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255
Mailing Address - Country:US
Mailing Address - Phone:802-362-9031
Mailing Address - Fax:802-362-7562
Practice Address - Street 1:7252 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER CTR
Practice Address - State:VT
Practice Address - Zip Code:05255
Practice Address - Country:US
Practice Address - Phone:802-362-9031
Practice Address - Fax:802-362-7562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420007111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006032Medicaid