Individual
DR. IAN CHARLES MICHELOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
85 SEYMOUR ST, HARTFORD, CT 06106-5501
(860) 545-8490
(860) 545-9371
Mailing address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-8360
(401) 444-5650
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
216301
MA
2080P0208X
Pediatric Infectious Diseases Physician
Primary
70212
CT
2080P0208X
Pediatric Infectious Diseases Physician
MD13482
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2026091
—
MA
01
—
468557
TUFTS HEALTH PLAN
MA
01
—
J26918
BCBS MA
MA
01
—
MD13482
LICENSE
RI
Enumeration date
10/26/2005
Last updated
05/07/2025
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