Healthcare Provider Details

I. General information

NPI: 1649833005
Provider Name (Legal Business Name): MICHAEL MAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 10/13/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CASTRO ST
SAN FRANCISCO CA
94114-1010
US

IV. Provider business mailing address

8 BUCHANAN ST UNIT 605
SAN FRANCISCO CA
94102-6296
US

V. Phone/Fax

Practice location:
  • Phone: 702-882-5285
  • Fax:
Mailing address:
  • Phone: 702-882-5285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberA178576
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: