Healthcare Provider Details

I. General information

NPI: 1003025800
Provider Name (Legal Business Name): W. MICHAEL CARRAGHER III, DO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7235 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046-6724
US

IV. Provider business mailing address

7235 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046-6724
US

V. Phone/Fax

Practice location:
  • Phone: 805-823-8204
  • Fax:
Mailing address:
  • Phone: 805-823-8204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A7692
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. W. MICHAEL CARRAGHER III
Title or Position: PRESIDENT
Credential: D.O.
Phone: 323-874-9355