Provider Demographics
NPI:1992844989
Name:MICHAEL, ADRIAN A (MD)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:A
Last Name:MICHAEL
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:PO BOX 1268
Mailing Address - Street 2:
Mailing Address - City:MESILLA
Mailing Address - State:NM
Mailing Address - Zip Code:88046-1268
Mailing Address - Country:US
Mailing Address - Phone:575-526-9189
Mailing Address - Fax:575-652-4064
Practice Address - Street 1:1770 TIERRA DE MESILLA
Practice Address - Street 2:
Practice Address - City:LA MESILLA
Practice Address - State:NM
Practice Address - Zip Code:88046
Practice Address - Country:US
Practice Address - Phone:575-526-9189
Practice Address - Fax:575-652-4064
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2004-0251207R00000X
NMMD2006-0771207RR0500X, 207R00000X
TXN8041207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM84576863Medicaid
NM84576863Medicaid