Provider Demographics
NPI:1477734267
Name:MICHELS, REBECCA (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:MICHELS
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:5619-25 VINE STREET
Mailing Address - Street 2:SPECTRUM HEALTH SERVICES, INC.
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-1302
Mailing Address - Country:US
Mailing Address - Phone:215-471-2761
Mailing Address - Fax:215-471-2929
Practice Address - Street 1:1415 NORTH BROAD STREET
Practice Address - Street 2:SUITE 224 BROAD STREET HEALTH CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-3323
Practice Address - Country:US
Practice Address - Phone:215-235-7944
Practice Address - Fax:215-235-3361
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT189477207Q00000X
PAMD436487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102380378Medicaid
NJ0209970Medicaid