Provider Demographics
NPI:1174583983
Name:CHRISSOS, MICHAEL GEORGE (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GEORGE
Last Name:CHRISSOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 0446 24 FRANK LLOYD WRIGHT DR.
Mailing Address - Street 2:LOBBY J IHA
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:5315 ELLIOTT DR
Practice Address - Street 2:SUITE #304
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8634
Practice Address - Country:US
Practice Address - Phone:734-712-0655
Practice Address - Fax:734-712-0611
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301072198207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3482173Medicaid
OM80710Medicare ID - Type Unspecified
MI3482173Medicaid