Provider Demographics
NPI:1598716870
Name:MICHEL, IMMACULA (MD)
Entity Type:Individual
Prefix:DR
First Name:IMMACULA
Middle Name:
Last Name:MICHEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 FOREST HILL BLVD
Mailing Address - Street 2:B-9
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6094
Mailing Address - Country:US
Mailing Address - Phone:561-968-7288
Mailing Address - Fax:561-968-7488
Practice Address - Street 1:1800 FOREST HILL BLVD
Practice Address - Street 2:B-9
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6094
Practice Address - Country:US
Practice Address - Phone:561-968-7288
Practice Address - Fax:561-968-7488
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301112432207Q00000X
FLACN97207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23888OtherMEDICARE PTAN
FLBM6676449OtherD EA
FLBM6676449OtherD EA