Provider Demographics
NPI:1558738799
Name:MICHAEL J PARIS, DPM
Entity Type:Organization
Organization Name:MICHAEL J PARIS, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-632-5264
Mailing Address - Street 1:250 FAME AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1587
Mailing Address - Country:US
Mailing Address - Phone:717-632-5264
Mailing Address - Fax:717-632-1165
Practice Address - Street 1:250 FAME AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1587
Practice Address - Country:US
Practice Address - Phone:717-632-5264
Practice Address - Fax:717-632-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004734L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2113979OtherALLIANCE
MD62019601OtherBLUE CROSS/ BLUE SHIELD MD
PA1467348OtherAMERIHEALTH ADMINISTRATOR
PA50038811OtherCAPITAL BLUE CROSS
PAU94855Medicare UPIN