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General NPI Number Information
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NPI Number | 1730113424
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Entity Type | Individual
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Provider Name | MICHELLE L DOUGLAS D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 05/31/2025
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Provider Practice Location Address
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Address Line | 34 MAPLE ST
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City | NORWALK
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State | CT
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Zip | 06850-3894
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Country | US
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Telephone | 203-852-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 191 N BROADWAY UNIT 707
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City | MILWAUKEE
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State | WI
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Zip | 53202-6032
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Country | US
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Telephone | 773-791-2444
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 295030
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 72895
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | DO3433
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License Number State | ME
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