Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 77277 | MA |
N | 208600000X | Surgeon | 77277 | MA |
Y | 2082S0105X | Plastic Hand Surgeon | 77277 | MA |
NPI | 1053354175 |
---|---|
Provider Name | Basil M. Michaels |
First Address | Pittsfield, MA 01201-8228 |
Second Address | Pittsfield, MA 01201-8228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 07/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
767791 | TUFTS (01) | MA |
G01967 | (02) | MA |
J16082 | BC/BS (01) | MA |