MEDICARE: MICHAEL CLARENCE SALZLE

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	198737	CA

General Provider Information

NPI Number	:	1578203063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CLARENCE SALZLE

Provider Business Mailing Address
First Line	:	26581 BRIDLEWOOD DR
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-7569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26581 BRIDLEWOOD DR
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-7569
Country	:	US
Telephone Number	:	949-939-3756
Fax Number	:

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

Provider Enumeration Date	:	03/31/2022
Last Update Date	:	01/14/2025

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