Basic Information
| Provider Information | |||||||||
| NPI: | 1457859407 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR. J. MICHAIL INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14860 ROSCOE BLVD | ||||||||
| Address2: | |||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914024665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187871049 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10515 BALBOA BLVD STE 290 | ||||||||
| Address2: | |||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913446362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188318999 | ||||||||
| FaxNumber: | 8188318990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2018 | ||||||||
| LastUpdateDate: | 06/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | MICHAIL | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8187871049 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 06/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | A142997 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.