Provider Demographics
NPI:1578563920
Name:MICHELS, DAWN MARIE (DPM)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MARIE
Last Name:MICHELS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 DUTCHMANS LN STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4710
Mailing Address - Country:US
Mailing Address - Phone:502-897-1794
Mailing Address - Fax:502-897-3852
Practice Address - Street 1:4130 DUTCHMANS LN STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4710
Practice Address - Country:US
Practice Address - Phone:502-897-1794
Practice Address - Fax:502-897-3852
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000979A213ES0103X
KY243966213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000334676OtherONE NATION
KY80000441Medicaid
P00145989OtherRAILROAD MEDICARE
IN000000334676OtherANTHEM
2446386000OtherPASSPORT ADVANTAGE
IN300079402Medicaid
KY50005049Medicaid
KY000000334676OtherANTHEM
IN200483320Medicaid
611327502OtherTRICARE FOR LIFE
611327502OtherHUMANA
000000334676OtherIN COMPREHENSIVE
611327502OtherTRICARE NORTH
000000334676OtherUNICARE
IN000000334676OtherANTHEM
KY0920902Medicare ID - Type Unspecified