Provider Demographics
NPI:1053354175
Name:MICHAELS, BASIL M (MD)
Entity type:Individual
Prefix:
First Name:BASIL
Middle Name:M
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8228
Mailing Address - Country:US
Mailing Address - Phone:413-496-9272
Mailing Address - Fax:413-442-6990
Practice Address - Street 1:426 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-8228
Practice Address - Country:US
Practice Address - Phone:413-496-9272
Practice Address - Fax:413-442-6990
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA772772082S0099X, 208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ16082OtherBC/BS
MA767791OtherTUFTS
MAJ16082OtherBC/BS
MAG01967Medicare UPIN