Provider Demographics
NPI:1356474076
Name:PLACE, MICHELLE JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:JEAN
Last Name:PLACE
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 1:919 SAN RAMON VALLEY BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4051
Mailing Address - Country:US
Mailing Address - Phone:925-837-1347
Mailing Address - Fax:925-314-9951
Practice Address - Street 1:919 SAN RAMON VALLEY BLVD STE 255
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4051
Practice Address - Country:US
Practice Address - Phone:925-837-1347
Practice Address - Fax:925-314-9951
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA050799208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG51502Medicare UPIN