MEDICARE: DR. VICTORIA MINER MICHAELS M.D.

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	174400000X	Specialist	229241	NY
2	207RR0500X	Rheumatology Physician	229241	NY

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	:	1871689869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTORIA MINER MICHAELS M.D.

Provider Business Mailing Address
First Line	:	6 WELLNESS WAY STE 201
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2156
Country	:	US
Telephone Number	:	518-782-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 WELLNESS WAY STE 113
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2142
Country	:	US
Telephone Number	:	518-782-3899
Fax Number	:	518-782-3884

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	03/30/2026

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