Provider Demographics
NPI:1285633990
Name:HELFGOTT, MICHELE L (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:HELFGOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1234 E DUPONT RD STE 3
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1545
Practice Address - Country:US
Practice Address - Phone:260-672-6590
Practice Address - Fax:260-672-6599
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044211A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000511560OtherANTHEM PROVIDER ID# - WHC
IN000000595616OtherANTHEM
IN200060320AMedicaid
IN200292470Medicaid
IN3013269OtherOH MEDICAID
INP00711628OtherMEDICARE RAILROAD
IN000000511560OtherANTHEM PROVIDER ID# - WHC
IN200060320AMedicaid
IN259190AMedicare PIN
IN200292470Medicaid