Provider Demographics
NPI:1417245382
Name:EPSTEIN, MICHELINE LATALIZA (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELINE
Middle Name:LATALIZA
Last Name:EPSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHELINE
Other - Middle Name:LATALIZA
Other - Last Name:MCBRINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4600 LAKE BOONE TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4600 LAKE BOONE TRL STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7529
Practice Address - Country:US
Practice Address - Phone:919-926-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275648207Q00000X
NC2019-01497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
WI331009Medicare Oscar/Certification
WI331043Medicare Oscar/Certification
WI331954Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
WI331946Medicare Oscar/Certification
WI331945Medicare Oscar/Certification
WI331952Medicare Oscar/Certification
NY00695941Medicaid
WI331058Medicare Oscar/Certification
WI331943Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
WI331947Medicare Oscar/Certification
WI331978Medicare Oscar/Certification