MEDICARE: MICHAEL K NAKATA M.D.

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	207L00000X	Anesthesiology Physician	G45916	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1780771550	OTHER	AR	NPI

General Provider Information

NPI Number	:	1780771550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL K NAKATA M.D.

Provider Business Mailing Address
First Line	:	72301 COUNTY CLUB DR #110
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-8007
Country	:	US
Telephone Number	:	760-776-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	72301 COUNTRY CLUB DR STE 110
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-8007
Country	:	US
Telephone Number	:	714-635-6272
Fax Number	:

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	05/12/2020

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