Provider Demographics
NPI:1124478250
Name:CHAMPIGNY, MICHELE ROSSI (DO)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ROSSI
Last Name:CHAMPIGNY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:MARIE
Other - Last Name:ROSSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1901 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5582
Mailing Address - Country:US
Mailing Address - Phone:772-335-7477
Mailing Address - Fax:
Practice Address - Street 1:1901 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5582
Practice Address - Country:US
Practice Address - Phone:772-335-7477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151010597208200000X, 208600000X
MI5101022679208600000X
FLOS20574208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery