=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710113634
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL D MICHEL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2009
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1133 EAGLES LANDING PKWY
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-5085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-604-1000
-----------------------------------------------------
Fax | 770-389-2133
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 950 N MERIDIAN ST STE 500
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46204-3908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-962-4942
-----------------------------------------------------
Fax | 317-962-4950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 01070422A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 104819
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------