Provider Demographics
NPI: | 1437191665 |
---|---|
Name: | HELMS, MICHAEL (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | MICHAEL |
Middle Name: | |
Last Name: | HELMS |
Suffix: | |
Gender: | M |
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: | 15944 ELMSFORD CT |
Mailing Address - Street 2: | |
Mailing Address - City: | GRANGER |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46530-7070 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 574-286-2432 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2930 W CLEVELAND RD |
Practice Address - Street 2: | |
Practice Address - City: | SOUTH BEND |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46628-6090 |
Practice Address - Country: | US |
Practice Address - Phone: | 574-335-8450 |
Practice Address - Fax: | 574-335-0780 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-12 |
Last Update Date: | 2018-03-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 01038531 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 000000927895 | Other | BCBS PC |
IN | 000000215759 | Other | BCBS |
IN | 000000927895 | Other | BCBS PC |
IN | IN2068003 | Medicare PIN | |
IN | IN1133010 | Medicare PIN | |
IN | E17124 | Medicare UPIN | |
IN | 100370170A | Medicaid | |
IN | 187710D | Medicare PIN |