Provider Demographics
NPI:1902807845
Name:MICHEL, ELLIOT MORTON (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:MORTON
Last Name:MICHEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 PENN ST STE B
Mailing Address - Street 2:
Mailing Address - City:BRACKENRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15014-1160
Mailing Address - Country:US
Mailing Address - Phone:724-226-9960
Mailing Address - Fax:724-226-9961
Practice Address - Street 1:985 PENN ST STE B
Practice Address - Street 2:
Practice Address - City:BRACKENRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15014-1160
Practice Address - Country:US
Practice Address - Phone:724-226-9960
Practice Address - Fax:724-226-9961
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019970E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC34202Medicare UPIN
PA441897JK9Medicare ID - Type Unspecified