Healthcare Provider Details

I. General information

NPI: 1093772543
Provider Name (Legal Business Name): MICHELE D SEMIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MACARTHUR BLVD
MUNSTER IN
46321-2901
US

IV. Provider business mailing address

PO BOX 10907
MERRILLVILLE IN
46411-0907
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-4569
  • Fax:
Mailing address:
  • Phone: 800-379-8731
  • Fax: 614-771-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036143191
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: