Healthcare Provider Details

I. General information

NPI: 1336144807
Provider Name (Legal Business Name): DAVID W MICHIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 E 6TH AVE
KENBRIDGE VA
23944-2050
US

IV. Provider business mailing address

306 E 6TH AVE
KENBRIDGE VA
23944-2050
US

V. Phone/Fax

Practice location:
  • Phone: 434-676-8021
  • Fax: 434-676-2390
Mailing address:
  • Phone: 434-676-8021
  • Fax: 434-676-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101058021
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: