Individual
MICHAEL A MEDEIROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2256 DOCKERY AVE STE B, SELMA, CA 93662-3874
(559) 856-6170
(559) 856-6172
Mailing address
4032 W SWANSON AVE, CARUTHERS, CA 93609-9552
(559) 856-6170
(559) 856-6172
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A117400
CA
2084N0600X
Clinical Neurophysiology Physician
Primary
64725
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12583839
CAQH NUMBER
CA
01
—
18511
LICENSE NUMBER
NV
01
—
A117400
LICENSE NUMBER
CA
Enumeration date
04/07/2008
Last updated
12/18/2019
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