MEDICARE: MIKHAIL MEYEROVICH MD

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	207Q00000X	Family Medicine Physician	A75992	CA
2	2084P0800X	Psychiatry Physician	A75992	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A75992	OTHER	CA	PTAN

General Provider Information

NPI Number	:	1073506952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKHAIL MEYEROVICH MD

Provider Business Mailing Address
First Line	:	5662 CALLE REAL
Second Line	:	#472
City	:	SANTA BARBARA
State	:	CA
Zip	:	93117-2317
Country	:	US
Telephone Number	:	805-284-6205
Fax Number	:

Provider Business Practice Location Address
First Line	:	5662 CALLE REAL
Second Line	:	#472
City	:	SANTA BARBARA
State	:	CA
Zip	:	93117-2317
Country	:	US
Telephone Number	:	805-284-6205
Fax Number	:

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	10/02/2007

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