Individual
MR. ELLIOTT P MIKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMT
Contact information
Practice address
1 EAGLE RD, CG ISLAND, ALAMEDA, CA 94501-5100
(510) 437-6641
(510) 437-3943
Mailing address
COMDT CG-1122 US COAST GUARD, 2100 2ND ST SW, SUITE 5314, WASHINGTON, DC 20593-0001
(510) 437-6641
(510) 437-3943
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
01/26/2007
Last updated
07/08/2007
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