Provider Demographics
NPI:1407920804
Name:TIMOTHY J MICHALS MD PC
Entity Type:Organization
Organization Name:TIMOTHY J MICHALS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MICHALS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-829-0331
Mailing Address - Street 1:125 S 9TH ST
Mailing Address - Street 2:SUITE 1003
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5125
Mailing Address - Country:US
Mailing Address - Phone:215-829-0331
Mailing Address - Fax:215-829-0338
Practice Address - Street 1:125 S 9TH ST
Practice Address - Street 2:SUITE 1003
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5125
Practice Address - Country:US
Practice Address - Phone:215-829-0331
Practice Address - Fax:215-829-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009566E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B96805Medicare UPIN
046630Medicare ID - Type Unspecified