MEDICARE: CARTER MICHAEL PRENTICE 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	208600000X	Surgery Physician	11507	CA

General Provider Information

NPI Number	:	1770231300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARTER MICHAEL PRENTICE MD

Provider Business Mailing Address
First Line	:	757 WESTWOOD PLZ
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-8358
Country	:	US
Telephone Number	:	424-467-5487
Fax Number	:

Provider Business Practice Location Address
First Line	:	757 WESTWOOD PLZ
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-5127
Country	:	US
Telephone Number	:	310-794-7788
Fax Number	:

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

Provider Enumeration Date	:	03/14/2022
Last Update Date	:	12/03/2023

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Directions to “ CARTER MICHAEL PRENTICE MD” Practice Location

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