MEDICARE: THEODORE W. MICHELL D.O.

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	207Q00000X	Family Medicine Physician	C2-0000265	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417954983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE W. MICHELL D.O.

Provider Business Mailing Address
First Line	:	1320 PHILADELPHIA PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19809-1818
Country	:	US
Telephone Number	:	302-798-0666
Fax Number	:	302-798-2401

Provider Business Practice Location Address
First Line	:	1320 PHILADELPHIA PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19809-1818
Country	:	US
Telephone Number	:	302-798-0666
Fax Number	:	302-798-2401

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/08/2007

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Directions to “ THEODORE W. MICHELL D.O.” Practice Location

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