Provider Demographics
NPI:1992731905
Name:PHEND, MICHAEL JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:PHEND
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 1:810 PARK PL
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3520
Mailing Address - Country:US
Mailing Address - Phone:574-472-6700
Mailing Address - Fax:574-472-6746
Practice Address - Street 1:5215 HOLY CROSS PARKWAY
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1469
Practice Address - Country:US
Practice Address - Phone:574-237-7168
Practice Address - Fax:574-472-6262
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030254A207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000626560OtherBCBS
IN100112690Medicaid
IN000000705131OtherANTHEM PROVIDER NUMBER - TIN 35-2030653
IN000000527516OtherANTHEM
INP00465474Medicare PIN
INM400041266Medicare PIN
IN100112690Medicaid
IN941050IIIIMedicare PIN
IN000000527516OtherANTHEM
INB28633Medicare UPIN
IN070880XMedicare PIN
INP01018481Medicare PIN