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General NPI Number Information
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NPI Number | 1841264454
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Entity Type | Individual
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Provider Name | MICHELLE MARIE PRINCE MD
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Gender | Female
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 5153 N 9TH AVE
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City | PENSACOLA
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State | FL
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Zip | 32504-8785
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Country | US
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Telephone | 850-416-1575
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Fax | 850-416-1302
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Provider Business Mailing Address
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Address Line | 301 N 8TH ST DEPT OF
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City | SPRINGFIELD
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State | IL
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Zip | 62701-1041
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Country | US
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Telephone | 217-757-6535
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | LT 3316
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | 036.131686
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | L6587
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | LT 3316
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License Number State | NH
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Taxonomy #5
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | ME143244
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License Number State | FL
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