Provider Demographics
NPI:1982660056
Name:MICHAELS, MICHAEL JEROME (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JEROME
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 1:271 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NH
Mailing Address - Zip Code:03870-2457
Mailing Address - Country:US
Mailing Address - Phone:603-430-2884
Mailing Address - Fax:
Practice Address - Street 1:17 OLD ROLLINSFORD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2833
Practice Address - Country:US
Practice Address - Phone:603-742-5011
Practice Address - Fax:603-742-3530
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12035174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH01Y005120NH01OtherBC/BS
ME287420099Medicaid
NHG97819OtherHARVARD PILGRIM
NH9230227OtherCIGNA
NH30204823Medicaid
NH7718562OtherAETNA
ME287420099Medicaid
NH9230227OtherCIGNA
NH01Y005120NH01OtherBC/BS