MEDICARE: DR. MICHAEL V. ELAM 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	C38533	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C38533	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1548343072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL V. ELAM M.D.

Provider Business Mailing Address
First Line	:	360 SAN MIGUEL DR STE 207
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7820
Country	:	US
Telephone Number	:	949-721-1113
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 SAN MIGUEL DR STE 207
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7820
Country	:	US
Telephone Number	:	949-721-1113
Fax Number	:

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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