Provider Demographics
NPI:1841234739
Name:PEARSON, MICHELLE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E CEDAR ST STE 405
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2059
Mailing Address - Country:US
Mailing Address - Phone:574-335-8707
Mailing Address - Fax:574-335-0741
Practice Address - Street 1:234 CHAPIN ST STE I
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-2571
Practice Address - Country:US
Practice Address - Phone:574-335-8250
Practice Address - Fax:574-335-0778
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057963A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1102532384OtherANTHEM BCBS
IN200448620AMedicaid
IN000000383677OtherBLUE CROSS
IN000000803535OtherBCBS
IN000001395568OtherANTHEM
IN000001417974OtherANTHEM
IN200448620AMedicaid
IN000000896332OtherANTHEM
IN000001071553OtherANTHEM
IN000000580319OtherBCBS
IN000001418127OtherANTHEM
IN000001395561OtherANTHEM
IN000001556379OtherANTHEM
IN000000616903OtherBCBS
IN738460005Medicare PIN
IN000000383677OtherBLUE CROSS
IN239010JMedicare PIN