Healthcare Provider Details

I. General information

NPI: 1013232925
Provider Name (Legal Business Name): KATRINA ELIZABETH MICHEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 WALNUT ST
BERKELEY CA
94709-1606
US

IV. Provider business mailing address

30 VALLEY VIEW DR
ORINDA CA
94563-3937
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-2566
  • Fax:
Mailing address:
  • Phone: 925-818-6988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA117715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: