MEDICARE: MIKE P FEALY 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	207P00000X	Emergency Medicine Physician	G63961	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457308868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKE P FEALY MD

Provider Business Mailing Address
First Line	:	1140 ORCHID DR
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93111-2913
Country	:	US
Telephone Number	:	805-637-6932
Fax Number	:

Provider Business Practice Location Address
First Line	:	6412 LAUREL AVE
Second Line	:	MOUNTAIN MESA
City	:	LAKE ISABELLA
State	:	CA
Zip	:	93240-9529
Country	:	US
Telephone Number	:	760-379-2681
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	06/09/2011

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