Provider Demographics
NPI:1245255520
Name:MICHEL, JOHN P (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:MICHEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:158 CROSSWYNDS DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1182
Mailing Address - Country:US
Mailing Address - Phone:724-891-1018
Mailing Address - Fax:
Practice Address - Street 1:1200 SHARON RD
Practice Address - Street 2:SUTIE 200
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-3148
Practice Address - Country:US
Practice Address - Phone:724-774-5030
Practice Address - Fax:724-774-5040
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018290E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008575080002Medicaid
PA0008575080002Medicaid
PA102059Medicare ID - Type Unspecified