Provider Demographics
NPI:1760855852
Name:MICHAEL, JEFFREY ADDISON (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ADDISON
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 AMALIA DR
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2239
Mailing Address - Country:US
Mailing Address - Phone:304-473-2000
Mailing Address - Fax:304-473-2057
Practice Address - Street 1:200 E STATE ST
Practice Address - Street 2:ATTN PODIATRY RESIDENTS
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601
Practice Address - Country:US
Practice Address - Phone:330-596-6000
Practice Address - Fax:330-596-7752
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH59.000578213ES0103X
WV10455213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery