Provider Demographics
NPI:1457302747
Name:MICHEL, JEAN-LUC (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN-LUC
Middle Name:
Last Name:MICHEL
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 1:29135 RYAN RD STE E
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4282
Mailing Address - Country:US
Mailing Address - Phone:248-951-8928
Mailing Address - Fax:248-951-2978
Practice Address - Street 1:29135 RYAN RD STE E
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4282
Practice Address - Country:US
Practice Address - Phone:248-951-8928
Practice Address - Fax:248-951-2978
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301111024208D00000X
PR10432208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF76007Medicare UPIN
PRHE235AMedicare PIN