Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | MD045335L | PA |
NPI | 1043384035 |
---|---|
Provider Name | Michael M Mikhail |
First Address | Broomall, PA 19008-3301 |
Second Address | Broomall, PA 19008-3301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 22/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00015550830002 | (05) | PA |
0276947000 | INDEPENDENCE BLUE CROSS (01) | PA |
147753 | BLUE SHIELD (01) | PA |
F40431 | (02) | PA |