Individual
MICHAEL B PLATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
415 E MADISON ST, SOUTH BEND, IN 46617-2322
(574) 533-1234
(574) 537-2652
Mailing address
415 E MADISON ST, SOUTH BEND, IN 46617-2322
(574) 533-1234
(574) 537-2652
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125052924
IL
2084P0800X
Psychiatry Physician
Primary
01070507A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01070507A
STATE LICENSE
IN
Enumeration date
01/13/2009
Last updated
07/24/2012
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