Healthcare Provider Details

I. General information

NPI: 1801840293
Provider Name (Legal Business Name): MIKAEL M PURNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23600 TELO AVE SUITE 180
TORRANCE CA
90505-4035
US

IV. Provider business mailing address

23600 TELO AVE SUITE 180
TORRANCE CA
90505-4035
US

V. Phone/Fax

Practice location:
  • Phone: 310-257-1500
  • Fax: 310-257-1511
Mailing address:
  • Phone: 310-257-1500
  • Fax: 310-257-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA43233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: