Provider Demographics
NPI:1790867703
Name:OAKERSON, MICHELLE MARIE (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:OAKERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:OAKERSON
Other - Last Name:BOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4625 S EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-5972
Mailing Address - Country:US
Mailing Address - Phone:317-522-2303
Mailing Address - Fax:317-522-2304
Practice Address - Street 1:4625 S EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-5972
Practice Address - Country:US
Practice Address - Phone:317-522-2303
Practice Address - Fax:317-522-2304
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101037731A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E92064Medicare UPIN