Healthcare Provider Details

I. General information

NPI: 1407960636
Provider Name (Legal Business Name): MICHELE RENEE BABIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 E STATE ROAD 64
BRADENTON FL
34208-9041
US

IV. Provider business mailing address

1250 S TAMIAMI TRL SUITE 201
SARASOTA FL
34239-2221
US

V. Phone/Fax

Practice location:
  • Phone: 941-748-1848
  • Fax: 941-748-1881
Mailing address:
  • Phone: 941-363-0878
  • Fax: 941-363-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01050539A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: