Healthcare Provider Details

I. General information

NPI: 1154479624
Provider Name (Legal Business Name): STUART MICHAEL PICKEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 HYDE STREET
SAN FRANCISCO CA
94109-4846
US

IV. Provider business mailing address

909 HYDE STREET
SAN FRANCISCO CA
94109-4846
US

V. Phone/Fax

Practice location:
  • Phone: 415-385-3367
  • Fax: 415-383-3649
Mailing address:
  • Phone: 415-385-3367
  • Fax: 415-383-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberC32405
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC32405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: