Provider Demographics
NPI:1891189015
Name:MORRIS, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W PUTNAM AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6079
Mailing Address - Country:US
Mailing Address - Phone:203-422-7250
Mailing Address - Fax:203-422-7251
Practice Address - Street 1:500 W PUTNAM AVE STE 100
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6079
Practice Address - Country:US
Practice Address - Phone:203-422-7250
Practice Address - Fax:203-422-7251
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD22638207R00000X
NY295500207R00000X
390200000X
CT70455207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program