Provider Demographics
NPI:1609880178
Name:MICHELS, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:MICHELS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3399 PGA BLVD
Mailing Address - Street 2:STE 350
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-624-0099
Mailing Address - Fax:561-624-7373
Practice Address - Street 1:3399 PGA BLVD
Practice Address - Street 2:STE 350
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-624-0099
Practice Address - Fax:561-624-7373
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME60054207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056453200Medicaid
FL056453200Medicaid
AH986Medicare PIN