Healthcare Provider Details

I. General information

NPI: 1063594687
Provider Name (Legal Business Name): MICHAEL SEAN TRAMELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 DOVE ST SUITE 170
NEWPORT BEACH CA
92660-2840
US

IV. Provider business mailing address

PO BOX 3868
MISSION VIEJO CA
92690-3868
US

V. Phone/Fax

Practice location:
  • Phone: 949-388-5042
  • Fax: 949-388-5042
Mailing address:
  • Phone: 949-388-5042
  • Fax: 949-388-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA85828
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberA85828
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA85828
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: