Basic Information
Provider Information
NPI: 1487606281
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LASH
FirstName: MICHAEL
MiddleName: B
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1600 9TH ST
Address2: ROOM 205 MAILSTOP 2-3
City: SACRAMENTO
State: CA
PostalCode: 958146414
CountryCode: US
TelephoneNumber: 9166542431
FaxNumber: 9166543186
Practice Location
Address1: 15000 ARNOLD DRIVE
Address2:  
City: SONOMA
State: CA
PostalCode: 954311493
CountryCode: US
TelephoneNumber: 7079386556
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/17/2006
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
207Q00000XA21710CAX Allopathic & Osteopathic PhysiciansFamily Medicine 
207Y00000XA21710CAX Allopathic & Osteopathic PhysiciansOtolaryngology 

No ID Information.


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