Healthcare Provider Details

I. General information

NPI: 1477203057
Provider Name (Legal Business Name): AMAURY I MICHEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19200 JAMBOREE RD STE 3100
IRVINE CA
92612-2571
US

IV. Provider business mailing address

19200 JAMBOREE RD STE 3100
IRVINE CA
92612-2571
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7002
  • Fax: 714-456-7002
Mailing address:
  • Phone: 714-456-7002
  • Fax: 714-456-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number036173455
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1477203057
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA210685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: