MEDICARE: DR. LAUREN G MICHALAKES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	015213	ME

General Provider Information

NPI Number	:	1093850059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN G MICHALAKES MD

Provider Business Mailing Address
First Line	:	901 WASHINGTON AVE
Second Line	:	SUITE 104
City	:	PORTLAND
State	:	ME
Zip	:	04103-2737
Country	:	US
Telephone Number	:	207-771-4770
Fax Number	:	207-775-5530

Provider Business Practice Location Address
First Line	:	901 WASHINGTON AVE
Second Line	:	SUITE 104
City	:	PORTLAND
State	:	ME
Zip	:	04103-2737
Country	:	US
Telephone Number	:	207-771-4770
Fax Number	:	207-775-5530

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	03/18/2009

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