Provider Demographics
NPI:1922072644
Name:MICHELS-ASHWOOD, KARIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KARIN
Middle Name:
Last Name:MICHELS-ASHWOOD
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 1:64 BLACK ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1200
Mailing Address - Country:US
Mailing Address - Phone:203-579-5000
Mailing Address - Fax:203-579-5113
Practice Address - Street 1:64 BLACK ROCK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1200
Practice Address - Country:US
Practice Address - Phone:203-579-5000
Practice Address - Fax:203-579-5113
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032193207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400057322Medicare Oscar/Certification