Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A80093 | CA |
NPI | 1023125259 |
---|---|
Provider Name | Dr. Michael Gary Michlitsch |
First Address | Walnut Creek, CA 94598-8396 |
Second Address | Walnut Creek, CA 94598-2512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 17/09/2020 |