Provider Demographics
NPI:1891807913
Name:MICHEL, STEVEN TED (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:TED
Last Name:MICHEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 PONDEROSA DRIVE NORTH
Mailing Address - Street 2:A105
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010
Mailing Address - Country:US
Mailing Address - Phone:805-482-0711
Mailing Address - Fax:805-482-6524
Practice Address - Street 1:2460 PONDEROSA DRIVE NORTH
Practice Address - Street 2:A105
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010
Practice Address - Country:US
Practice Address - Phone:805-482-0711
Practice Address - Fax:805-482-6524
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1845213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E18450OtherMEDICAL
T11074Medicare UPIN
E1845Medicare PIN