Healthcare Provider Details

I. General information

NPI: 1104433226
Provider Name (Legal Business Name): MICHELLE CUMMINS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/05/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CARLTON AVE STE 200
LOS GATOS CA
95032-2629
US

IV. Provider business mailing address

PO BOX 25576
BELFAST ME
04915-2006
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-6234
  • Fax: 408-358-3389
Mailing address:
  • Phone: 415-645-4528
  • Fax: 510-581-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6055
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: