Healthcare Provider Details

I. General information

NPI: 1346273687
Provider Name (Legal Business Name): LYLE J MICHELI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 LONGWOOD AVE
BOSTON MA
02115-5728
US

IV. Provider business mailing address

319 LONGWOOD AVE
BOSTON MA
02115-5728
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-3501
  • Fax: 617-731-5298
Mailing address:
  • Phone: 617-355-6028
  • Fax: 617-731-5298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number31190
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: