Healthcare Provider Details

I. General information

NPI: 1225130867
Provider Name (Legal Business Name): MICHAEL A WOODS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ROOSEVELT RD
VALPARAISO IN
46383-2800
US

IV. Provider business mailing address

PO BOX 194
SOUTH BEND IN
46624-0194
US

V. Phone/Fax

Practice location:
  • Phone: 219-477-5242
  • Fax: 219-477-4859
Mailing address:
  • Phone: 219-477-5242
  • Fax: 219-477-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01048590A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: