Provider Demographics
NPI:1841459971
Name:CLEAVES, MICHAEL CHRISTOPHER (IDC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:CLEAVES
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 HEWITT DR
Mailing Address - Street 2:UCT-ONE
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23521-2519
Mailing Address - Country:US
Mailing Address - Phone:757-462-3992
Mailing Address - Fax:757-462-8142
Practice Address - Street 1:1465 HEWITT DR
Practice Address - Street 2:UCT-ONE
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23521-2519
Practice Address - Country:US
Practice Address - Phone:757-462-3992
Practice Address - Fax:757-462-8142
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman