Provider Demographics
NPI:1164692265
Name:DAVID P MICHELIN MD PC
Entity Type:Organization
Organization Name:DAVID P MICHELIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:MICHELIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-935-0971
Mailing Address - Street 1:315 N DIVISION ST
Mailing Address - Street 2:STE 220
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2009
Mailing Address - Country:US
Mailing Address - Phone:231-935-0971
Mailing Address - Fax:231-935-0572
Practice Address - Street 1:315 N DIVISION ST
Practice Address - Street 2:STE 220
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2009
Practice Address - Country:US
Practice Address - Phone:231-935-0971
Practice Address - Fax:231-935-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056115207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3476846Medicaid
MI3476846Medicaid
MIG12828Medicare UPIN