Provider Demographics
NPI:1851309660
Name:MICHAELS, ALVIN BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:BARRY
Last Name:MICHAELS
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 1:30100 TELEGRAPH RD
Mailing Address - Street 2:STE 330
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4517
Mailing Address - Country:US
Mailing Address - Phone:248-645-5510
Mailing Address - Fax:248-645-0899
Practice Address - Street 1:30100 TELEGRAPH RD
Practice Address - Street 2:STE 330
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4517
Practice Address - Country:US
Practice Address - Phone:248-645-5510
Practice Address - Fax:248-645-0899
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010243712084P0800X
CAC000246332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0635990OtherBCBS MICHIGAN
MI1081012Medicaid
MI038765OtherVALUEOPTIONS
MI038765OtherVALUEOPTIONS