Provider Demographics
NPI:1881883452
Name:MICHELS, TERRY ALBERT
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ALBERT
Last Name:MICHELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61500 GORDONS FERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:HAPPY CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:96039-0701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:61500 GORDONS FERRY ROAD
Practice Address - Street 2:
Practice Address - City:HAPPY CAMP
Practice Address - State:CA
Practice Address - Zip Code:96039-0701
Practice Address - Country:US
Practice Address - Phone:530-493-2786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG11922208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice