Provider Demographics
NPI:1457939852
Name:WINCHESTER, MICHAEL EUGENE
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EUGENE
Last Name:WINCHESTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-1054
Mailing Address - Country:US
Mailing Address - Phone:484-816-4801
Mailing Address - Fax:
Practice Address - Street 1:104 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1054
Practice Address - Country:US
Practice Address - Phone:484-816-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA9854324175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay