Provider Demographics
NPI:1982749503
Name:DR. MICHAEL ENGLERT
Entity Type:Organization
Organization Name:DR. MICHAEL ENGLERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-282-2305
Mailing Address - Street 1:PO BOX 1591
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46634-1591
Mailing Address - Country:US
Mailing Address - Phone:574-282-2305
Mailing Address - Fax:574-288-4997
Practice Address - Street 1:100 NAVARRE PL
Practice Address - Street 2:STE 6640
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1156
Practice Address - Country:US
Practice Address - Phone:574-282-2305
Practice Address - Fax:574-288-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1028951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND94930Medicare UPIN