Provider Demographics
NPI:1275600371
Name:MYERS, MICHAEL T (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:MYERS
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:PO BOX 3868
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47737-3868
Mailing Address - Country:US
Mailing Address - Phone:812-426-9565
Mailing Address - Fax:812-426-9572
Practice Address - Street 1:8600 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-6302
Practice Address - Country:US
Practice Address - Phone:812-426-9565
Practice Address - Fax:812-426-9572
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056009A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64046683OtherKY MEDICAID
IN000000218438OtherANTHEM
IN200371090Medicaid
IN200371090Medicaid
IN849800JJJMedicare PIN
IN257900UUMedicare PIN
INH58103Medicare UPIN