Provider Demographics
NPI:1497751556
Name:ABELES, MICHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHA
Middle Name:
Last Name:ABELES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHA
Other - Middle Name:
Other - Last Name:ABELES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:816 BROAD ST STE 14
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:816 BROAD ST STE 14
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4350
Practice Address - Country:US
Practice Address - Phone:203-235-6402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT020484207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1497751556Medicaid
CT490000173Medicare PIN