=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467854588
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL IAN PAUL M.D.,A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2014
-----------------------------------------------------
Last Update Date | 09/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 N BEDFORD DR
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90210-5129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-274-4362
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20038 PACIFIC COAST HWY
-----------------------------------------------------
City | MALIBU
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90265-5422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-227-4436
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL IAN PAUL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-274-4362
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number | A22542
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------