# MICHAEL T. VERCILLO, M.D., INC.

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

## Provider details

- **NPI number:** 1871818815
- **Authorized official:** DR. MICHAEL T VERCILLO M.D. (PRESIDENT, CEO)
- **Authorized official phone:** (310) 600-0111

## Contact information

- **Practice address:** 375 ROLLING OAKS DR, SUITE 200, THOUSAND OAKS, CA 91361-1023
- **Practice address phone:** (805) 497-9481
- **Practice address fax:** (805) 497-3416
- **Mailing address:** 375 ROLLING OAKS DR, SUITE 200, THOUSAND OAKS, CA 91361-1023
- **Mailing address phone:** (805) 497-9481
- **Mailing address fax:** (805) 497-3416

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | A85526 | CA | Yes |

## Other

- **Enumeration date:** 04/01/2010
- **Last updated:** 04/01/2010