Provider Demographics
NPI:1295117745
Name:PAINTSIL, MIKE
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:PAINTSIL
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 1:12 HATIKVA WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2333
Mailing Address - Country:US
Mailing Address - Phone:978-677-1867
Mailing Address - Fax:
Practice Address - Street 1:12 HATIKVA WAY
Practice Address - Street 2:
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2333
Practice Address - Country:US
Practice Address - Phone:978-677-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS90514904172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver