Provider Demographics
NPI:1558409326
Name:AFFEMANN, MICHAEL ULRICH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ULRICH
Last Name:AFFEMANN
Suffix:
Gender:M
Credentials:PHD
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 505
Mailing Address - Street 2:
Mailing Address - City:KURE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28449-0505
Mailing Address - Country:US
Mailing Address - Phone:910-458-5675
Mailing Address - Fax:
Practice Address - Street 1:205 RALEIGH AVE
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-4904
Practice Address - Country:US
Practice Address - Phone:910-458-5675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1491103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0406KMedicare UPIN