MEDICARE: CARMICHAEL PEDIATRIC MEDICAL GROUP, INC.

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	208000000X	Pediatrics Physician	A56390	CA

General Provider Information

NPI Number	:	1407032816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARMICHAEL PEDIATRIC MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	5841 JAMESON CT
Second Line	:	#1
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-0895
Country	:	US
Telephone Number	:	916-485-9800
Fax Number	:	916-485-9810

Provider Business Practice Location Address
First Line	:	5841 JAMESON CT
Second Line	:	#1
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-0895
Country	:	US
Telephone Number	:	916-485-9800
Fax Number	:	916-485-9810

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAVINDER S KHAIRA
Credential	:	M.D.
Telephone Number	:	916-485-9800

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	11/25/2009

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