Basic Information
Provider Information
NPI: 1538145362
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HLINKA
FirstName: MICHAEL
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2190 LYNN RD
Address2: SUITE 220
City: THOUSAND OAKS
State: CA
PostalCode: 913601980
CountryCode: US
TelephoneNumber: 8054958050
FaxNumber: 8054962160
Practice Location
Address1: 215 WEST JANSS ROAD
Address2: RADIOLOGY DEPARTMENT
City: THOUSAND OAKS
State: CA
PostalCode: 91360
CountryCode: US
TelephoneNumber: 8054972727
FaxNumber: 8054950023
Other Information
ProviderEnumerationDate: 12/22/2005
LastUpdateDate: 02/09/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XA78819CAY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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