Healthcare Provider Details

I. General information

NPI: 1841264454
Provider Name (Legal Business Name): MICHELLE MARIE PRINCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5153 N 9TH AVE
PENSACOLA FL
32504-8785
US

IV. Provider business mailing address

301 N 8TH ST DEPT OF
SPRINGFIELD IL
62701-1041
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-1575
  • Fax: 850-416-1302
Mailing address:
  • Phone: 217-757-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberLT 3316
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number036.131686
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberL6587
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberLT 3316
License Number StateNH
# 5
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME143244
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: