Provider Demographics
NPI:1164435079
Name:GELINAS, MICHEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:P
Last Name:GELINAS
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 1:7066 HWY J
Mailing Address - Street 2:
Mailing Address - City:ST GERMAIN
Mailing Address - State:WI
Mailing Address - Zip Code:54558
Mailing Address - Country:US
Mailing Address - Phone:715-479-3406
Mailing Address - Fax:715-356-2257
Practice Address - Street 1:1020 3RD AVE
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568-1520
Practice Address - Country:US
Practice Address - Phone:715-356-2262
Practice Address - Fax:715-356-2257
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39723207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32412700Medicaid
WI000151035Medicare PIN
WI32412700Medicaid
F15966Medicare UPIN