Provider Demographics
NPI:1831106194
Name:TEMPLE, MICHAEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:TEMPLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L-3401
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-3401
Mailing Address - Country:US
Mailing Address - Phone:740-615-1324
Mailing Address - Fax:740-615-1344
Practice Address - Street 1:4141 NORTH HAMPTON DR
Practice Address - Street 2:SUITE 103
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7063
Practice Address - Country:US
Practice Address - Phone:614-764-9955
Practice Address - Fax:740-615-2849
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-3261-T174400000X
OH353073261208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2136067Medicaid
TE0875351Medicare PIN
H09744Medicare UPIN