MEDICARE: MICHAEL DINNEL D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	E1978	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000E19780	OTHER	CA	BLUE CROSS/SHIELD NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000E19780	OTHER	CA	TRICARE NUMBER

General Provider Information

NPI Number	:	1497759096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DINNEL D.P.M.

Provider Business Mailing Address
First Line	:	986 VISTA VILLAGE DR
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92084-6064
Country	:	US
Telephone Number	:	760-758-5751
Fax Number	:	760-758-4356

Provider Business Practice Location Address
First Line	:	986 VISTA VILLAGE DR
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92084-6064
Country	:	US
Telephone Number	:	760-758-5751
Fax Number	:	760-758-4356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/09/2007

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