Provider Demographics
NPI:1013745538
Name:SEVERT, MICHAEL STEVEN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEVEN
Last Name:SEVERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 MCGILLIVRAY AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-5618
Mailing Address - Country:US
Mailing Address - Phone:937-727-7099
Mailing Address - Fax:
Practice Address - Street 1:1422 MCGILLIVRAY AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-5618
Practice Address - Country:US
Practice Address - Phone:937-727-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program