Provider Demographics
NPI:1891723334
Name:MICHLEWITZ, HAROLD (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:MICHLEWITZ
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 1:680 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3308
Mailing Address - Country:US
Mailing Address - Phone:508-941-7009
Mailing Address - Fax:508-941-6337
Practice Address - Street 1:650 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:508-580-8682
Practice Address - Fax:508-583-2515
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37493207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2032716Medicaid
MA2032716Medicaid
MAM09125401Medicare PIN