Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | C33136 | CA |
N | 207R00000X | Internist | C331360 | CA |
N | 111NI0900X | Internist | C331360 | CA |
N | 208000000X | Pediatrician | C331360 | CA |
NPI | 1023065760 |
---|---|
Provider Name | Dr. Michael Andre Lenoir |
First Address | Oakland, CA 94609-3405 |
Second Address | Oakland, CA 94612-3756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 02/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A35175 | (02) | |
OOC13360 | (05) | CA |