Individual
MICHAEL A MEDEIROS
Active
Individual
MICHAEL A MEDEIROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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