Provider Demographics
NPI:1518019124
Name:MICHELSEN, CAROLE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:
Last Name:MICHELSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 VAN CORTLANDT PARK SOUTH
Mailing Address - Street 2:ST. PATRICKS HOME
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:212-216-6807
Mailing Address - Fax:212-216-6606
Practice Address - Street 1:66 VAN CORTLANDT PARK SOUTH
Practice Address - Street 2:ST. PATRICKS HOME
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:212-216-6807
Practice Address - Fax:212-216-6606
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171397207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F40500Medicare UPIN