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General NPI Number Information
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NPI Number | 1386634756
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Entity Type | Individual
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Provider Name | IAN CHARLES MICHELOW MD
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 85 SEYMOUR ST
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City | HARTFORD
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State | CT
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Zip | 06106-5501
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Country | US
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Telephone | 860-545-8490
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Fax | 860-545-9371
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Provider Business Mailing Address
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Address Line | 593 EDDY ST
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City | PROVIDENCE
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State | RI
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Zip | 02903-4923
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Country | US
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Telephone | 401-444-8360
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Fax | 401-444-5650
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 216301
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number | MD13482
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number | 70212
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License Number State | CT
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