Provider Demographics
NPI:1699767269
Name:REGAN, MICHAEL P (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:REGAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1022
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45401-1022
Mailing Address - Country:US
Mailing Address - Phone:937-221-8555
Mailing Address - Fax:937-567-4170
Practice Address - Street 1:425 W GRAND AVE STE 3002
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4722
Practice Address - Country:US
Practice Address - Phone:937-723-4231
Practice Address - Fax:937-734-4170
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002164R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0530527Medicaid
OH4280581OtherMEDICARE PTAN NUMBER
OHU27623Medicare UPIN