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General NPI Number Information
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NPI Number | 1740622232
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Entity Type | Organization
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Legal Business Name | MARK MIKHAEL INC
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Dates
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Enumeration Date | 07/24/2013
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 2625 W ALAMEDA AVE SUITE 116
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City | BURBANK
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State | CA
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Zip | 91505-4806
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Country | US
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Telephone | 818-841-3936
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Fax | 818-841-5974
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Provider Business Mailing Address
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Address Line | 2625 W ALAMEDA AVE SUITE 116
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City | BURBANK
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State | CA
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Zip | 91505-4806
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Country | US
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Telephone | 818-841-3936
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Fax | 818-841-5974
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK M MIKHAEL
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Credential | M.D.
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Telephone | 818-841-3936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | A105078
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License Number State | CA
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