Provider Demographics
NPI:1447312749
Name:MICHAELS, MARLA D (MD)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:D
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4447 TURNBERRY PL
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3824
Mailing Address - Country:US
Mailing Address - Phone:850-630-6707
Mailing Address - Fax:850-833-7439
Practice Address - Street 1:137 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5063
Practice Address - Country:US
Practice Address - Phone:850-833-7500
Practice Address - Fax:850-833-7528
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1120062084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004621500Medicaid
GA049317OtherLICENSE
FL004621500Medicaid