Provider Demographics
NPI:1275525743
Name:ADDIS, MICHAEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:ADDIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:433 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2520
Mailing Address - Country:US
Mailing Address - Phone:973-759-9000
Mailing Address - Fax:973-759-2487
Practice Address - Street 1:649 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1518
Practice Address - Country:US
Practice Address - Phone:973-379-7920
Practice Address - Fax:973-379-7921
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2019-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA078551002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093243A3WMedicare PIN
NJI36570Medicare UPIN