MEDICARE: DR. MICHELLE FLEETWOOD DVM, DACVP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174M00000X	Veterinarian

General Provider Information

NPI Number	:	1942284245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE FLEETWOOD DVM, DACVP

Provider Business Mailing Address
First Line	:	4401 MAPLE AVE
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-4732
Country	:	US
Telephone Number	:	301-654-0288
Fax Number	:	202-782-9150

Provider Business Practice Location Address
First Line	:	AFIP BLDG 54 RM G117 DEPT VETERINARY PATHOLOGY
Second Line	:	14TH ST AND ALASKA AVE, NW
City	:	WASHINGTON
State	:	DC
Zip	:	20306-0001
Country	:	US
Telephone Number	:	202-782-2442
Fax Number	:	202-782-9150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	07/08/2007

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