Basic Information
| Provider Information | |||||||||
| NPI: | 1508807793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALBERT | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1 CHILDRENS PLZ | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454041815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376413000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 CHILDRENS PLZ | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454041815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376414000 | ||||||||
| FaxNumber: | 9376414500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 050826 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XP3100X | 35.050826 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 05280 | 01 | OH | PARAMOUNT | OTHER | 6849598002 | 01 | OH | CIGNA | OTHER | 226116 | 01 | OH | UNISON | OTHER | 278468 | 01 | OH | AMERIGROUP | OTHER | 914700400 | 05 | FL | MEDICAID | 0561440 | 05 | OH | MEDICAID | 2263452 | 01 | OH | AETNA | OTHER | 0920110 | 01 | OH | UNITED HEALTHCARE | OTHER | 100384370 | 05 | IN | MEDICAID | 200037199 | 01 | OH | MEDICARE RAILROAD | OTHER | 311676182026 | 01 | OH | CARESOURCE | OTHER | 738695 | 01 | OH | BUCKEYE | OTHER | 64957111 | 05 | KY | MEDICAID | 74053 | 01 | OH | BC/BS | OTHER | 0561440 | 01 | OH | BCMH | OTHER |