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NPI Code Detail

MEDICARE: DR. PAUL O. MICHELS MD

MEDICARE: DR. PAUL O. MICHELS 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
12084P0800XPsychiatry PhysicianMD00041723WA
22084P0800XPsychiatry Physician5063AK
32084P0800XPsychiatry PhysicianMD21199OR
42084P0800XPsychiatry Physician42539MN

General Provider Information

NPI Number : 1265586440
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAUL O. MICHELS MD
Provider Business Mailing Address
First Line : 4262 BLUE DIAMOND RD # 102-378
Second Line :
City : LAS VEGAS
State : NV
Zip : 89139-7789
Country : US
Telephone Number : 971-404-4740
Fax Number : 954-212-0237
Provider Business Practice Location Address
First Line : 603 BRUCE ST
Second Line :
City : CROOKSTON
State : MN
Zip : 56716-2914
Country : US
Telephone Number : 281-281-3940
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2007
Last Update Date : 03/16/2018

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