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NPI Code Detail

MEDICARE: DR. MICHAEL A BACKLUND PHD

MEDICARE: DR. MICHAEL A BACKLUND PHD
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
1103TC0700XClinical PsychologistPSY13331CA

General Provider Information

NPI Number : 1932268646
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL A BACKLUND PHD
Provider Business Mailing Address
First Line : 5100 O BRYNES FERRY RD
Second Line :
City : JAMESTOWN
State : CA
Zip : 95327-9102
Country : US
Telephone Number : 209-984-5291
Fax Number :
Provider Business Practice Location Address
First Line : 5100 O BRYNES FERRY RD
Second Line :
City : JAMESTOWN
State : CA
Zip : 95327-9102
Country : US
Telephone Number : 209-984-5291
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2006
Last Update Date : 07/08/2007

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