Provider Demographics
NPI:1104433226
Name:CUMMINS, MICHELLE (DPM)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25576
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2006
Mailing Address - Country:US
Mailing Address - Phone:415-645-4528
Mailing Address - Fax:510-581-7779
Practice Address - Street 1:400 CARLTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2629
Practice Address - Country:US
Practice Address - Phone:408-358-6234
Practice Address - Fax:408-358-3389
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE6055213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery