Provider Demographics
NPI:1346247061
Name:WORPELL, MICHAEL STEVEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEVEN
Last Name:WORPELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1234 E DUPONT RD
Mailing Address - Street 2:2 1
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-416-0070
Mailing Address - Fax:260-416-0017
Practice Address - Street 1:1234 E DUPONT RD
Practice Address - Street 2:2 1
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1545
Practice Address - Country:US
Practice Address - Phone:260-416-0070
Practice Address - Fax:260-416-0017
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000957A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000250200OtherANTHEM ID NUMBER
IN4868080001OtherDMERC
INP00108081OtherRAILROAD MEDICARE
000000250200OtherANTHEM ID NUMBER
IN4868080001OtherDMERC