Healthcare Provider Details

I. General information

NPI: 1295439636
Provider Name (Legal Business Name): MICHAEL AMEDEO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 LOMITA BLVD STE 120
TORRANCE CA
90505-1907
US

IV. Provider business mailing address

PO BOX 841868
LOS ANGELES CA
90084-5054
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-0011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number6267
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number6267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: