Individual
DR. MICHAEL JAMES PHEND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5215 HOLY CROSS PARKWAY, MISHAWAKA, IN 46545-1469
(574) 237-7168
(574) 472-6262
Mailing address
810 PARK PL, MISHAWAKA, IN 46545-3520
(574) 472-6700
(574) 472-6746
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01030254A
IN
208M00000X
Hospitalist Physician
01030254A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000527516
ANTHEM
IN
01
—
000000626560
BCBS
IN
01
—
000000705131
ANTHEM PROVIDER NUMBER - TIN 35-2030653
IN
05
—
100112690
—
IN
Enumeration date
06/23/2006
Last updated
05/17/2012
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