Provider Demographics
NPI:1336258979
Name:MICHAELS, ALEXIS B (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:B
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4337 E GRAND RIVER AVE # 208
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-6583
Mailing Address - Country:US
Mailing Address - Phone:248-504-0588
Mailing Address - Fax:
Practice Address - Street 1:7575 GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9309
Practice Address - Country:US
Practice Address - Phone:248-504-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056369207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4450352Medicaid
MI0N12200084Medicare ID - Type Unspecified
MIF77729Medicare UPIN