Provider Demographics
NPI:1154735140
Name:WORKMAN, MICHAEL (MSN, PMHNP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:WORKMAN
Suffix:
Gender:M
Credentials:MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:707 N MICHIGAN ST STE 400
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1071
Practice Address - Country:US
Practice Address - Phone:574-647-8470
Practice Address - Fax:574-647-8475
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28130042A363LP0808X
IN71004997A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000886472OtherBCBS BMG BEHAVIORAL HEALTH
IN000000923971OtherBCBS BMG BEHAVIORAL HEALTH
IN000000883510OtherBCBS BMG IRELAND
IN000000883509OtherBCBS BMG MAIN STREET
INP01579587OtherRR MEDICARE
IN000000882979OtherBCBS BMG LAPORTE
IN201243450Medicaid
INP01579587OtherRR MEDICARE
IN169380010Medicare PIN
IN201243450Medicaid
IN236040103Medicare PIN