Healthcare Provider Details

I. General information

NPI: 1104323823
Provider Name (Legal Business Name): MICHELLE MORATH DN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 MCLEOD RD NE STE A
ALBUQUERQUE NM
87109-2467
US

IV. Provider business mailing address

5800 MCLEOD RD NE STE A
ALBUQUERQUE NM
87109-2467
US

V. Phone/Fax

Practice location:
  • Phone: 505-550-8322
  • Fax: 505-435-9735
Mailing address:
  • Phone: 505-550-8322
  • Fax: 505-435-9735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number01028
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: