Provider Demographics
NPI:1992122048
Name:MICHEL, ERIBERTO (MD)
Entity type:Individual
Prefix:
First Name:ERIBERTO
Middle Name:
Last Name:MICHEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 WALNUT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6729
Mailing Address - Country:US
Mailing Address - Phone:206-465-2611
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST.
Practice Address - Street 2:COX 630
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-0211
Practice Address - Country:US
Practice Address - Phone:206-465-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125066029208G00000X
MA288175208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110176748AMedicaid
NH3131601Medicaid