Basic Information
Provider Information
NPI: 1588687172
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MICHEO
FirstName: WILLIAM
MiddleName: F.
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 66 CALLE SANTA CRUZ
Address2: INSTITUTO SAN PABLO 301
City: BAYAMON
State: PR
PostalCode: 009617041
CountryCode: US
TelephoneNumber: 7877402270
FaxNumber: 7877857277
Practice Location
Address1: 66 CALLE SANTA CRUZ
Address2: INSTITUTO SAN PABLO 301
City: BAYAMON
State: PR
PostalCode: 009617041
CountryCode: US
TelephoneNumber: 7877402270
FaxNumber: 7877857277
Other Information
ProviderEnumerationDate: 07/25/2006
LastUpdateDate: 10/13/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2081S0010X8274PRY Allopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine

No ID Information.


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