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Individual

MIKE IRA ISHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1550 SPRINGFIELD DR APT 60, CHICO, CA 95928-6334
(530) 624-1776
Mailing address
1550 SPRINGFIELD DR APT 60, CHICO, CA 95928-6334
(530) 624-1776

Taxonomy

Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
C3244694
CA

Other

Enumeration date
08/30/2022
Last updated
08/30/2022
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Product
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