Provider Demographics
NPI:1194924738
Name:MICHLI, EDDIE E (MD)
Entity type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:E
Last Name:MICHLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3588
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-1210
Practice Address - Street 1:115 WATER ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3015
Practice Address - Country:US
Practice Address - Phone:508-482-5411
Practice Address - Fax:508-482-5417
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0067773208800000X
NJMA08231300208800000X
MA246328208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2802711OtherUNITED HEALTH CARE
NJ60033609OtherHORIZON NJ HEALTH
NJ01004599400OtherAMERICHOICE
NJ0136514Medicaid
NJP3807804OtherOXFORD
MA1100884441AMedicaid
NJ1686964OtherAETNA
NJ3433401000OtherAMERIHEALTH/KEYSTONE/IBC
NJ3K6567OtherHEALTHNET
NJ4358685OtherCIGNA
NJ44821OtherUNIVERISTY HEALTH PLAN
NJP3807804OtherOXFORD