Provider Demographics
NPI:1720081961
Name:MICHELSON, MARC ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALAN
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 1:1201 11TH AVE S
Mailing Address - Street 2:STE 501
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-3423
Mailing Address - Country:US
Mailing Address - Phone:205-930-0930
Mailing Address - Fax:205-930-9050
Practice Address - Street 1:1201 11TH AVE S
Practice Address - Street 2:STE 501
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3423
Practice Address - Country:US
Practice Address - Phone:205-930-0930
Practice Address - Fax:205-930-9050
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7455207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000051072Medicaid
AL180037822OtherMEDICARE TRAVELERS
AL510-51072MICOtherBLUE CROSS BLUE SHIELD
AL0810046OtherUNITED HEALTHCARE
AL0488291OtherUMWA
AL180037822OtherPALMETTO GBA-MEDICARE
ALC75218OtherVIVA
ALC75218Medicare UPIN
AL000051072Medicaid