MEDICARE: DR. EMANUAL MICHAEL MAVERAKIS 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	207N00000X	Dermatology Physician	A91555	CA

General Provider Information

NPI Number	:	1942274592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMANUAL MICHAEL MAVERAKIS M.D.

Provider Business Mailing Address
First Line	:	2416 50TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-1503
Country	:	US
Telephone Number	:	916-734-6371
Fax Number	:	916-734-6793

Provider Business Practice Location Address
First Line	:	3301 C ST
Second Line	:	STE 100
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-3300
Country	:	US
Telephone Number	:	916-734-6371
Fax Number	:	916-734-6793

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	07/08/2007

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