Healthcare Provider Details

I. General information

NPI: 1710190657
Provider Name (Legal Business Name): MICHAEL L STREAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 OVERLAND AVE 259
CULVER CITY CA
90230-4289
US

IV. Provider business mailing address

4900 OVERLAND AVE 259
CULVER CITY CA
90230-4289
US

V. Phone/Fax

Practice location:
  • Phone: 310-839-9724
  • Fax: 310-839-9724
Mailing address:
  • Phone: 310-839-9724
  • Fax: 310-839-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC34005
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC34005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: