Provider Demographics
NPI:1255372389
Name:MICHELSON, ALEXEI D (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXEI
Middle Name:D
Last Name:MICHELSON
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 1:24800 CHRISANTA DR
Mailing Address - Street 2:SUITE #260
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4833
Mailing Address - Country:US
Mailing Address - Phone:949-462-9114
Mailing Address - Fax:949-460-9114
Practice Address - Street 1:24800 CHRISANTA DR
Practice Address - Street 2:SUITE #260
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4833
Practice Address - Country:US
Practice Address - Phone:949-462-9114
Practice Address - Fax:949-460-9114
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA563092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG61808Medicare UPIN
CAA56309Medicare ID - Type Unspecified