Provider Demographics
NPI:1578504320
Name:BESS, MICHAEL D (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:BESS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W 5TH AVE
Mailing Address - Street 2:SUITE 137
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2310
Mailing Address - Country:US
Mailing Address - Phone:276-679-9600
Mailing Address - Fax:423-239-3003
Practice Address - Street 1:1601 W 5TH AVE
Practice Address - Street 2:SUITE 137
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2310
Practice Address - Country:US
Practice Address - Phone:276-679-9600
Practice Address - Fax:423-239-3003
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050052207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010288258Medicaid
VA008979W63Medicare ID - Type Unspecified
VA010288258Medicaid
F00659Medicare UPIN