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NPI Code Detail

MEDICARE: MICHAEL DACEY MD

MEDICARE: MICHAEL DACEY 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
1207ND0101XMOHS-Micrographic Surgery PhysicianA81790CA
2207N00000XDermatology PhysicianA81790CA

General Provider Information

NPI Number : 1184604217
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL DACEY MD
Provider Business Mailing Address
First Line : 2950 RESEARCH PARK DR
Second Line :
City : SOQUEL
State : CA
Zip : 95073-2000
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2950 RESEARCH PARK DR
Second Line :
City : SOQUEL
State : CA
Zip : 95073-2000
Country : US
Telephone Number : 831-458-5548
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2006
Last Update Date : 10/12/2020

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