Provider Demographics
NPI:1578647137
Name:FINE, MICHAEL G (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:FINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 N HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-7036
Mailing Address - Country:US
Mailing Address - Phone:703-528-7177
Mailing Address - Fax:703-522-2963
Practice Address - Street 1:1307 N HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-7036
Practice Address - Country:US
Practice Address - Phone:703-528-7177
Practice Address - Fax:703-522-2963
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000376213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA177818Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
VAT31003Medicare UPIN