Healthcare Provider Details

I. General information

NPI: 1740209402
Provider Name (Legal Business Name): MICHAEL J. VOVAKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 PLACER ST
REDDING CA
96001-1125
US

IV. Provider business mailing address

PO BOX 992790
REDDING CA
96099-2790
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-5710
  • Fax: 530-241-7838
Mailing address:
  • Phone: 530-246-5710
  • Fax: 530-241-7838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG38769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: