Provider Demographics
NPI:1174598254
Name:MICHAEL, DAVID K (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:830 W LAKE LANSING RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6371
Mailing Address - Country:US
Mailing Address - Phone:517-333-3777
Mailing Address - Fax:517-203-3948
Practice Address - Street 1:830 W LAKE LANSING RD
Practice Address - Street 2:SUITE 190
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6371
Practice Address - Country:US
Practice Address - Phone:517-333-3777
Practice Address - Fax:517-203-3948
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101006941207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1017935OtherMCLAREN HEALTH PLAN
MI4838583Medicaid
MI200000001133OtherPHYSICIANS HEALTH PLAN
MIE25716Medicare UPIN
MIP26020001Medicare ID - Type Unspecified
MI0C36179Medicare ID - Type UnspecifiedMEDICARE-OLIN