Basic Information
Provider Information
NPI: 1326242009
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SONGER
FirstName: MICHAEL
MiddleName: LEE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 13320 PERGOLA AVE
Address2:  
City: BAKERSFIELD
State: CA
PostalCode: 933148508
CountryCode: US
TelephoneNumber: 6615880761
FaxNumber:  
Practice Location
Address1: WASCO STATE PRISON
Address2: 701 SCOFIELD AVE.
City: WASCO
State: CA
PostalCode: 932808800
CountryCode: US
TelephoneNumber: 6617588400
FaxNumber: 6617587088
Other Information
ProviderEnumerationDate: 06/14/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QA0505XC42388CAY Allopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine

No ID Information.


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