MEDICARE: DR. MICHAEL JEROME SINGLETON M.D., MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A064610	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WA64610A	OTHER	CA	MEDICARE #

General Provider Information

NPI Number	:	1013918119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JEROME SINGLETON M.D., MBA

Provider Business Mailing Address
First Line	:	PO BOX 5167
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92052-5167
Country	:	US
Telephone Number	:	310-600-6046
Fax Number	:	323-750-0330

Provider Business Practice Location Address
First Line	:	8880 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-3635
Country	:	US
Telephone Number	:	323-750-1197
Fax Number	:	323-750-0330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	10/13/2011

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