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Individual

MICHAEL JOHN PORTAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
71 HAYNES ST, MANCHESTER, CT 06040-4188
(860) 646-1222
Mailing address
71 HAYNES ST, MANCHESTER, CT 06040-4188
(860) 646-1222

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
363AS0400X
Surgical Physician Assistant
Primary
6494
CT

Other

Enumeration date
11/13/2023
Last updated
05/06/2026
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