Provider Demographics
NPI:1679752026
Name:MICHAELS, PAUL KENNETH (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:KENNETH
Last Name:MICHAELS
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 1:818 MAIN LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3727
Mailing Address - Country:US
Mailing Address - Phone:321-841-6547
Mailing Address - Fax:321-841-5103
Practice Address - Street 1:818 MAIN LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3727
Practice Address - Country:US
Practice Address - Phone:321-841-6547
Practice Address - Fax:321-841-5103
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005914207QA0505X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine