Provider Demographics
NPI:1013085471
Name:MICHELIS, MICHAEL FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANK
Last Name:MICHELIS
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 1:130 E 77TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1851
Mailing Address - Country:US
Mailing Address - Phone:212-988-3506
Mailing Address - Fax:212-734-2133
Practice Address - Street 1:130 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1851
Practice Address - Country:US
Practice Address - Phone:212-988-3506
Practice Address - Fax:212-734-2133
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093082207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11818Medicare UPIN
NY680901Medicare ID - Type Unspecified
NYW89141Medicare PIN