Provider Demographics
NPI:1497465819
Name:WEST, MICHAEL JOSEPH
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:WEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807B TOWNSHIP ROAD 161
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:OH
Mailing Address - Zip Code:43334-9463
Mailing Address - Country:US
Mailing Address - Phone:760-818-5457
Mailing Address - Fax:
Practice Address - Street 1:3807B TOWNSHIP ROAD 161
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:OH
Practice Address - Zip Code:43334-9463
Practice Address - Country:US
Practice Address - Phone:760-818-5457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant