Provider Demographics
NPI:1124034186
Name:MICHAELS, M. ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:M.
Middle Name:ELIZABETH
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CRITTENDEN BLVD
Mailing Address - Street 2:BOX PSYCH
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-4501
Mailing Address - Fax:585-273-1130
Practice Address - Street 1:300 CRITTENDEN BLVD
Practice Address - Street 2:BOX PSYCH
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-4501
Practice Address - Fax:585-273-1130
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2363162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
P010236316OtherBLUE CHOICE
P020236316OtherROCHESTER BLUE SHIELD
NYRA7833OtherRAILROAD MEDICARE
NYP010236316OtherBLUE CHOICE
NY02685752Medicaid
176437EUOtherPREFERRED CARE
7324099OtherAETNA
NY176437EUOtherPREFERRED CHOICE
P020236316OtherROCHESTER BLUE SHIELD
P010236316OtherBLUE CHOICE
7324099OtherAETNA