Basic Information
| Provider Information | |||||||||
| NPI: | 1174773253 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL H. BISHOP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5761 E LA PALMA AVE | ||||||||
| Address2: | #261 | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928072229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192586200 | ||||||||
| FaxNumber: | 6192580028 | ||||||||
| Practice Location | |||||||||
| Address1: | 751 W LEGION RD | ||||||||
| Address2: | BUILDING 2, #205 | ||||||||
| City: | BRAWLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922277732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603514848 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2008 | ||||||||
| LastUpdateDate: | 09/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | BISHOP | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7142735687 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0005X | 20A5759 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine |
No ID Information.