Provider Demographics
NPI:1376743997
Name:MIKAEL MEDICAL ASSOCIATES INC.
Entity type:Organization
Organization Name:MIKAEL MEDICAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERK
Authorized Official - Prefix:
Authorized Official - First Name:NAGY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-899-7100
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-0002
Mailing Address - Country:US
Mailing Address - Phone:781-330-1010
Mailing Address - Fax:
Practice Address - Street 1:747 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3327
Practice Address - Country:US
Practice Address - Phone:781-330-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-22
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9718966Medicaid
MAM21339Medicare PIN