Basic Information
| Provider Information | |||||||||
| NPI: | 1194027854 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR MIKEL WALK IN CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15791 BEAR VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | HESPERIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923451746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609491231 | ||||||||
| FaxNumber: | 7609491236 | ||||||||
| Practice Location | |||||||||
| Address1: | 20258 US HIGHWAY 18 | ||||||||
| Address2: | STE 450 | ||||||||
| City: | APPLE VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923076197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609618125 | ||||||||
| FaxNumber: | 7609491236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2010 | ||||||||
| LastUpdateDate: | 11/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | ALWIS | ||||||||
| AuthorizedOfficialFirstName: | MIKEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7602219298 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DR MIKEL WALK IN CLINIC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | A48518 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.