Healthcare Provider Details

I. General information

NPI: 1548240021
Provider Name (Legal Business Name): CHRISTOPHER S MICHEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 MILVIA ST SUITE 300
BERKELEY CA
94704-2685
US

IV. Provider business mailing address

2020 MILVIA ST SUITE 300
BERKELEY CA
94704-2685
US

V. Phone/Fax

Practice location:
  • Phone: 510-843-2220
  • Fax: 510-809-1779
Mailing address:
  • Phone: 510-843-2220
  • Fax: 510-809-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG27712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: