MEDICARE: DR. MELVYN J MICHAELIAN 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	208600000X	Surgery Physician	G14877	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	YYY49687Y	OTHER	CA	SOUTHERN BLUE SHIELD
2	ZZZ27707Z	OTHER	CA	NORTHERN BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427053438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELVYN J MICHAELIAN M.D.

Provider Business Mailing Address
First Line	:	521 E ELDER ST
Second Line	:	STE 205
City	:	FALLBROOK
State	:	CA
Zip	:	92028-3083
Country	:	US
Telephone Number	:	760-728-6106
Fax Number	:	760-728-4547

Provider Business Practice Location Address
First Line	:	521 E ELDER ST
Second Line	:	STE 205
City	:	FALLBROOK
State	:	CA
Zip	:	92028-3083
Country	:	US
Telephone Number	:	760-728-6106
Fax Number	:	760-728-4547

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/29/2007

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