1134123920 NPI number — DR. MARCIA A MICHALIK M.D.

Table of content: DR. MARCIA A MICHALIK M.D. (NPI 1134123920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134123920 NPI number — DR. MARCIA A MICHALIK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHALIK
Provider First Name:
MARCIA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134123920
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1081 N CHINA LAKE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGECREST
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93555-3130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-499-3855
Provider Business Mailing Address Fax Number:
760-499-3870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 N CHINA LAKE BLVD STE 190
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-3131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-499-3855
Provider Business Practice Location Address Fax Number:
760-499-3870
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  G32768 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G32768 . This is a "IMG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G327680 . This is a "COMMERCIAL CARRIERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G327680 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G327680 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 93555B034 . This is a "TRIWEST/TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G327680 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: CA0103 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0616650001 . This is a "DME" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com