Provider Demographics
NPI:1982622239
Name:TOPOR, MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:TOPOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:7905 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2549
Practice Address - Country:US
Practice Address - Phone:219-836-3296
Practice Address - Fax:219-836-3295
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007705A225100000X
IL070015412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201340970Medicaid
IL1619908OtherBCBS IL GROUP
IL567700OtherMEDICARE GROUP NUMBER
IL568080OtherMEDICARE GROUP NUMBER
IL568150OtherMEDICARE GROUP NUMBER
IN471400288OtherMEDICARE PTAN
ILK50670Medicare PIN
ILK50672Medicare PIN
IL567700OtherMEDICARE GROUP NUMBER