MEDICARE: MICHAEL MCCUTCHEON GREEN D.O.

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	20A4975	CA
2	2083X0100X	Occupational Medicine Physician	20A4975	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20A4975	OTHER	CA	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1902944788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MCCUTCHEON GREEN D.O.

Provider Business Mailing Address
First Line	:	2720 N HARBOR BLVD
Second Line	:	130
City	:	FULLERTON
State	:	CA
Zip	:	92835-2609
Country	:	US
Telephone Number	:	714-449-6200
Fax Number	:	714-449-6283

Provider Business Practice Location Address
First Line	:	2720 N HARBOR BLVD
Second Line	:	130
City	:	FULLERTON
State	:	CA
Zip	:	92835-2609
Country	:	US
Telephone Number	:	714-449-6200
Fax Number	:	714-449-6283

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	09/11/2025

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