Provider Demographics
NPI:1215097969
Name:MICHEL, CARL LOUIS (RPA-C)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:LOUIS
Last Name:MICHEL
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MECHANIC ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1869
Mailing Address - Country:US
Mailing Address - Phone:732-450-2610
Mailing Address - Fax:
Practice Address - Street 1:65 MECHANIC ST
Practice Address - Street 2:SUITE 105
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1869
Practice Address - Country:US
Practice Address - Phone:732-450-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00209600363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP98628Medicare UPIN