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General NPI Number Information
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NPI Number | 1164692265
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Entity Type | Organization
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Legal Business Name | DAVID P MICHELIN MD PC
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 07/03/2012
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Provider Practice Location Address
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Address Line | 315 N DIVISION ST STE 220
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2009
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Country | US
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Telephone | 231-935-0971
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Fax | 231-935-0572
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Provider Business Mailing Address
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Address Line | 315 N DIVISION ST STE 220
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2009
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Country | US
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Telephone | 231-935-0971
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Fax | 231-935-0572
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID P MICHELIN
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Credential | MD
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Telephone | 231-935-0971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 4301056115
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License Number State | MI
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