Provider Demographics
NPI:1871689869
Name:MICHAELS, VICTORIA MINER (MD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:MINER
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6 WELLNESS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2156
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:6 WELLNESS WAY STE 113
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2142
Practice Address - Country:US
Practice Address - Phone:518-782-3899
Practice Address - Fax:518-782-3884
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-09-13
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Provider Licenses
StateLicense IDTaxonomies
NY229241174400000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02493194Medicaid
NYH89545Medicare UPIN