Provider Demographics
NPI:1487656161
Name:ISRAEL, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:ISRAEL
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:PO BOX 3395
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47732-3395
Mailing Address - Country:US
Mailing Address - Phone:812-801-0715
Mailing Address - Fax:812-265-6603
Practice Address - Street 1:630 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250
Practice Address - Country:US
Practice Address - Phone:812-801-0889
Practice Address - Fax:812-801-0441
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056102A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000497811OtherANTHEM BCBS
IN7774367OtherAETNA
KY50012817Medicaid
IN089817OtherSIHO
IN200375780Medicaid
IN200375780Medicaid
IN000000497811OtherANTHEM BCBS
IN563420Medicare ID - Type UnspecifiedM-CARE GROUP NUMBER
KY50012817Medicaid
INH59633Medicare UPIN