Individual
DR. MICHEL RIVLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5373
(601) 984-5476
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5373
(601) 984-5476
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
8037
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00016020
—
MS
01
—
08103071
UP MEDICAID GROUP PROV#
MS
01
—
160039244
RR MEDICARE NUMBER
MS
01
—
512G700003
UP MEDICARE GROUP PROV#
MS
01
—
512I160014
MEDICARE PTAN
MS
01
—
P00616899
UP RR MEDICARE PTAN#
MS
Enumeration date
06/28/2006
Last updated
08/14/2012
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