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NPI Code Detail

MEDICARE: MICHAEL D THIBERT PA

MEDICARE: MICHAEL D THIBERT PA
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
1363A00000XPhysician AssistantPA12103CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00165970OTHERCARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659301208
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL D THIBERT PA
Provider Business Mailing Address
First Line : 475 BRUCE ST
Second Line :
City : YREKA
State : CA
Zip : 96097-3474
Country : US
Telephone Number : 530-842-1267
Fax Number : 530-842-9121
Provider Business Practice Location Address
First Line : 475 BRUCE ST
Second Line :
City : YREKA
State : CA
Zip : 96097-3474
Country : US
Telephone Number : 530-842-1267
Fax Number : 530-842-9121
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 04/02/2013

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Directions to “ MICHAEL D THIBERT PA” Practice Location

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