Provider Demographics
NPI:1952479396
Name:MISCH, MICHELLE MONICA (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MONICA
Last Name:MISCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 JOANNE DR
Mailing Address - Street 2:APT. NO. 208
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-6601
Mailing Address - Country:US
Mailing Address - Phone:951-536-1910
Mailing Address - Fax:
Practice Address - Street 1:5841 JOANNE DR
Practice Address - Street 2:APT. NO. 208
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-6601
Practice Address - Country:US
Practice Address - Phone:951-536-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117401172V00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care