Healthcare Provider Details

I. General information

NPI: 1720200850
Provider Name (Legal Business Name): MICHAEL F BISHARA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6896 MAGNOLIA AVE
RIVERSIDE CA
92506-2843
US

IV. Provider business mailing address

6896 MAGNOLIA AVE
RIVERSIDE CA
92506-2843
US

V. Phone/Fax

Practice location:
  • Phone: 951-787-4885
  • Fax: 951-787-4962
Mailing address:
  • Phone: 951-787-4885
  • Fax: 951-787-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberA43206
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA43206
License Number StateCA

VIII. Authorized Official

Name: MICHAEL F BISHARA
Title or Position: OWNER
Credential:
Phone: 951-787-4885