MEDICARE: CATHY J MICHAELIS

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1811176282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHY J MICHAELIS

Provider Business Mailing Address
First Line	:	10750 CEDAR WAY
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-4833
Country	:	US
Telephone Number	:	530-477-8375
Fax Number	:	530-477-8375

Provider Business Practice Location Address
First Line	:	10750 CEDAR WAY
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-4833
Country	:	US
Telephone Number	:	530-477-8375
Fax Number	:	530-477-8375

Authorized Official
Title or Position	:	OWNER/BILLER
Name	:	MRS. CATHY J MICHAELIS
Credential	:
Telephone Number	:	530-477-8375

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	06/16/2008

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