MEDICARE: REYADH J MICHAIL 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	207Q00000X	Family Medicine Physician	A41791	CA

General Provider Information

NPI Number	:	1508847831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REYADH J MICHAIL M.D

Provider Business Mailing Address
First Line	:	14860 ROSCOE BLVD
Second Line	:	#201
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4665
Country	:	US
Telephone Number	:	818-787-1049
Fax Number	:	818-787-1129

Provider Business Practice Location Address
First Line	:	14860 ROSCOE BLVD
Second Line	:	SUITE#201
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4665
Country	:	US
Telephone Number	:	818-787-1049
Fax Number	:	818-787-1129

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	07/08/2007

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