Individual
THEODORE MICLAU III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2550 23RD ST BLDG 9, 2ND FLOOR, SAN FRANCISCO, CA 94110-3504
(415) 206-8812
(415) 647-3733
Mailing address
2550 23RD ST BLDG 9, 2ND FLOOR, SAN FRANCISCO, CA 94110-3504
(415) 206-8812
(415) 647-3733
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G81843
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G818430
—
CA
01
—
110150231
RAILROAD MEDICARE
CA
Enumeration date
05/20/2006
Last updated
01/09/2012
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