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General NPI Number Information
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NPI Number | 1669906632
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Entity Type | Individual
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Provider Name | MICHAEL PHILIPPONE DO
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Gender | Male
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 350 HAWTHORNE AVE
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City | OAKLAND
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State | CA
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Zip | 94609-3108
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Country | US
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Telephone | 585-466-4123
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Fax | 774-217-7252
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Provider Business Mailing Address
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Address Line | 1498 PACIFIC AVE STE 400
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City | TACOMA
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State | WA
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Zip | 98402-4208
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Country | US
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Telephone |
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Fax | 774-217-7252
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | DO2734
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34.016531
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A16883
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License Number State | CA
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