Provider Demographics
NPI:1578192878
Name:STAPLES, MICAH ANDREW (DO)
Entity type:Individual
Prefix:DR
First Name:MICAH
Middle Name:ANDREW
Last Name:STAPLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GOVERNORS DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5123
Mailing Address - Country:US
Mailing Address - Phone:256-536-5511
Mailing Address - Fax:
Practice Address - Street 1:1851 N MCKENZIE ST STE 200
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-4700
Practice Address - Country:US
Practice Address - Phone:251-424-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.2702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine