Provider Demographics
NPI:1407960636
Name:BABIN, MICHELE RENEE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:RENEE
Last Name:BABIN
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 1:1250 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2221
Mailing Address - Country:US
Mailing Address - Phone:941-363-0878
Mailing Address - Fax:941-363-0527
Practice Address - Street 1:3809 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-9041
Practice Address - Country:US
Practice Address - Phone:941-748-1848
Practice Address - Fax:941-748-1881
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050539A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200238380Medicaid
IN000000514647OtherANTHEM PIN
IN200238380Medicaid
IN000000514647OtherANTHEM PIN
226830TTMedicare PIN