Healthcare Provider Details

I. General information

NPI: 1174978498
Provider Name (Legal Business Name): BAY AREA RADIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MISSION ST UNIT 39D
SAN FRANCISCO CA
94105-2243
US

IV. Provider business mailing address

PO BOX 2488 UNIT #20
PORTLAND OR
97208-2488
US

V. Phone/Fax

Practice location:
  • Phone: 559-455-4009
  • Fax: 916-533-0313
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BARBARA MICHAELIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 541-808-0400