Healthcare Provider Details

I. General information

NPI: 1548365737
Provider Name (Legal Business Name): MICHEAL MCBAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 WILSHIRE BLVD APT 1002
LOS ANGELES CA
90024-4559
US

IV. Provider business mailing address

10535 WILSHIRE BLVD APT 1002
LOS ANGELES CA
90024-4559
US

V. Phone/Fax

Practice location:
  • Phone: 310-387-9357
  • Fax:
Mailing address:
  • Phone: 310-387-9357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG63748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: