Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | A105078 | CA |
NPI | 1346446101 |
---|---|
Provider Name | Dr. Mark Mikhael |
First Address | Burbank, CA 91505-4806 |
Second Address | Burbank, CA 91505-4806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 20/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CB202926 | (02) | CA |