Provider Demographics
NPI:1730171893
Name:MICHEL, BRIAN E (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:E
Last Name:MICHEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 KINGS HWY S
Mailing Address - Street 2:BUILDING 5
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2500
Mailing Address - Country:US
Mailing Address - Phone:856-428-8992
Mailing Address - Fax:856-428-9614
Practice Address - Street 1:401 KINGS HWY S STE 5
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2500
Practice Address - Country:US
Practice Address - Phone:856-428-8992
Practice Address - Fax:856-428-9614
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06824800207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1110344Medicaid
NJ078146AB5Medicare PIN
A63919Medicare UPIN
NJP00149487Medicare PIN