Provider Demographics
NPI:1609809847
Name:WEST, MICHAELA A (MD, PHD)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:A
Last Name:WEST
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:A
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:3300 OAKDALE AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2926
Mailing Address - Country:US
Mailing Address - Phone:763-581-3700
Mailing Address - Fax:763-581-3701
Practice Address - Street 1:3300 OAKDALE AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2926
Practice Address - Country:US
Practice Address - Phone:763-581-3700
Practice Address - Fax:763-581-3701
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88483208600000X, 2086S0102X, 2086S0127X
MN266192086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A12228Medicare UPIN
IL917930Medicare PIN