Individual
MICHAEL SUMMERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12101 CAROL LN STE 101, FREDERICKSBURG, VA 22407-6104
(540) 741-9300
Mailing address
250 N SHADELAND AVE, STE 130, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
0101273522
VA
207Q00000X
Family Medicine Physician
Primary
0101273522
VA
207Q00000X
Family Medicine Physician
01034573A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000599162
ANTHEM PIN#
—
05
—
100348400
—
IN
01
—
P00696807
RR MCR#
—
Enumeration date
07/27/2006
Last updated
07/14/2025
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