Provider Demographics
NPI:1154434298
Name:HENSEL, MICHELLE R (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:HENSEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 PIPER ST
Mailing Address - Street 2:SUITE 1060
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4665
Mailing Address - Country:US
Mailing Address - Phone:907-212-6522
Mailing Address - Fax:907-212-6593
Practice Address - Street 1:417 FIRST AVENUE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664
Practice Address - Country:US
Practice Address - Phone:907-224-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKP00756937OtherRAILROAD MEDICARE PIN
AKMD29533Medicaid
AKDB2364OtherRAILROAD MEDICARE GROUP #
AKMD29533Medicaid
AKDB2364OtherRAILROAD MEDICARE GROUP #