MEDICARE: DR. MICHAEL DENNIS KIFUNE MD

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	207Q00000X	Family Medicine Physician	G39833	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578568614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DENNIS KIFUNE MD

Provider Business Mailing Address
First Line	:	PO BOX 939
Second Line	:
City	:	ANGELS CAMP
State	:	CA
Zip	:	95222-0939
Country	:	US
Telephone Number	:	209-754-6240
Fax Number	:	866-894-1902

Provider Business Practice Location Address
First Line	:	1333 HIGHWAY 49
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249-9618
Country	:	US
Telephone Number	:	209-755-1400
Fax Number	:	209-755-1430

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	09/24/2014

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