MEDICARE: DR. MICHELLE SHIREEN KOLSI 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	208000000X	Pediatrics Physician	A93068	CA

General Provider Information

NPI Number	:	1821294307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE SHIREEN KOLSI M.D.

Provider Business Mailing Address
First Line	:	110 W STOCKER ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2509
Country	:	US
Telephone Number	:	818-244-7237
Fax Number	:	818-244-6787

Provider Business Practice Location Address
First Line	:	110 W STOCKER ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2509
Country	:	US
Telephone Number	:	818-244-7237
Fax Number	:	818-244-6787

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	05/05/2017

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