Provider Demographics
NPI:1316947724
Name:MULTZ, MICHELLE AUDREY (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:AUDREY
Last Name:MULTZ
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1100
Mailing Address - Fax:952-942-3361
Practice Address - Street 1:285 SILLS RD
Practice Address - Street 2:BUILDING 18
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:952-942-3361
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1759212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01444384Medicaid
NY300110620OtherRAILROAD MEDICARE
NY300110620OtherRAILROAD MEDICARE
NY02I423Medicare ID - Type Unspecified