# MICHAEL M. FANOUS, D.P.M., INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083796726
- **Authorized official:** DR. MICHAEL M. FANOUS D.P.M. (PRESIDENT)
- **Authorized official phone:** (760) 951-1238

## Contact information

- **Practice address:** 15366 11TH ST, SUITE D, VICTORVILLE, CA 92395-3726
- **Practice address phone:** (760) 951-1238
- **Mailing address:** 2834 HAMNER AVE, \# 113, NORCO, CA 92860-1929
- **Mailing address phone:** (760) 951-1238

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | E3544 | CA | Yes |

## Other

- **Enumeration date:** 10/20/2006
- **Last updated:** 07/31/2008