Provider Demographics
NPI:1841282712
Name:HUMEN, MICAHEL JOHN (ATC, MED)
Entity type:Individual
Prefix:MR
First Name:MICAHEL
Middle Name:JOHN
Last Name:HUMEN
Suffix:
Gender:M
Credentials:ATC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 KESTREL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-2605
Mailing Address - Country:US
Mailing Address - Phone:570-868-3131
Mailing Address - Fax:
Practice Address - Street 1:159 KESTREL RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-2605
Practice Address - Country:US
Practice Address - Phone:570-868-3131
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001759A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PART001759AOtherSTATE LICENSE