MEDICARE: DR. MICHAEL HONORE CRIQUI M.D.

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	2083P0901X	Public Health & General Preventive Medicine Physician	A24283	CA

General Provider Information

NPI Number	:	1245653146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL HONORE CRIQUI M.D.

Provider Business Mailing Address
First Line	:	9500 GILMAN DR
Second Line	:	MAIL CODE 0607
City	:	LA JOLLA
State	:	CA
Zip	:	92093-0607
Country	:	US
Telephone Number	:	858-534-3722
Fax Number	:	858-246-0298

Provider Business Practice Location Address
First Line	:	9500 GILMAN DR
Second Line	:	MAIL CODE 0607
City	:	LA JOLLA
State	:	CA
Zip	:	92093-0607
Country	:	US
Telephone Number	:	858-534-3722
Fax Number	:	858-246-0298

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

Provider Enumeration Date	:	01/28/2014
Last Update Date	:	01/28/2014

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