Provider Demographics
NPI:1497717441
Name:MICHAELS, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8324 OSWEGO RD
Mailing Address - Street 2:STE D
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1086
Mailing Address - Country:US
Mailing Address - Phone:315-652-6551
Mailing Address - Fax:315-652-9698
Practice Address - Street 1:8100 OSWEGO RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1654
Practice Address - Country:US
Practice Address - Phone:315-652-6551
Practice Address - Fax:315-652-9698
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-02-08
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Provider Licenses
StateLicense IDTaxonomies
NY228536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00169389OtherRAILROAD MEDICARE
P00169389OtherRAILROAD MEDICARE