Provider Demographics
NPI:1245203454
Name:ISRAEL, MICHAEL ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:ISRAEL
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 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1863
Mailing Address - Fax:047-522-0307
Practice Address - Street 1:18181 OAKWOOD BLVD STE 212
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-5031
Practice Address - Country:US
Practice Address - Phone:313-438-7397
Practice Address - Fax:313-438-7398
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010441712086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI020H263670OtherBCBSM GROUP PIN#
MI02-0822061-1OtherBCBSM INDIVIDUAL PIN#
MI4235319Medicaid
MIB9840OtherMCARE INDIVIDUAL PIN#
MIH26367005Medicare ID - Type Unspecified
MIB9840OtherMCARE INDIVIDUAL PIN#