=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528086766
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FREDERICK J. MICHEL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 11/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 NYES RD # II SUITE F
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17112-3247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-214-6545
-----------------------------------------------------
Fax | 717-531-0639
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 CENTERVIEW DR PO BOX 855 MC A525
-----------------------------------------------------
City | HERSHEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17033-2902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-531-5944
-----------------------------------------------------
Fax | 717-531-4188
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 440867
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------