Healthcare Provider Details

I. General information

NPI: 1558397331
Provider Name (Legal Business Name): MEDHAT FOUAD MIKHAEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 05/20/2022
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 ATLANTIC AVE
LONG BEACH CA
90807-3418
US

IV. Provider business mailing address

16787 BEACH BLVD # 276
HUNTINGTON BEACH CA
92647-4848
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-0060
  • Fax: 562-595-0027
Mailing address:
  • Phone: 714-340-7240
  • Fax: 562-595-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA55997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: