Provider Demographics
NPI:1689641557
Name:RAYMOND, MICHELE L (DO)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2425 MILITARY ST
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6692
Mailing Address - Country:US
Mailing Address - Phone:810-984-5700
Mailing Address - Fax:810-984-1886
Practice Address - Street 1:2425 MILITARY ST
Practice Address - Street 2:BUILDING 2
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6692
Practice Address - Country:US
Practice Address - Phone:810-984-5700
Practice Address - Fax:810-984-1886
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2014-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689641557Medicaid
MI1689641557Medicaid