Individual
DR. MICHELLE KATHLEEN BACARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5 PINE WEST PLZ STE 512, ALBANY, NY 12205-5587
(518) 650-6674
(518) 641-1651
Mailing address
PO BOX 13373, ALBANY, NY 12212
(518) 650-6674
(518) 641-1651
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
00209508
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000412260001
BLUE SHIELD
—
05
—
00209508
—
NY
01
—
53088A
MVP PROVIDER
NY
Enumeration date
07/06/2006
Last updated
06/28/2023
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