Provider Demographics
NPI:1700859766
Name:RENFORTH, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:RENFORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5508
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23471-0508
Mailing Address - Country:US
Mailing Address - Phone:757-340-3489
Mailing Address - Fax:757-340-4278
Practice Address - Street 1:120 MONTICELLO AVE
Practice Address - Street 2:MICHUMI, PLLC., DBA MD EXPRESS OF WILLIAMSBURG VA
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2840
Practice Address - Country:US
Practice Address - Phone:757-564-3627
Practice Address - Fax:757-564-6449
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101231161207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010094348Medicaid
VAP00153222OtherRRMED
VA010094348Medicaid
VA00W070M01Medicare PIN