Individual
DR. MELVYN J MICHAELIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
521 E ELDER ST, STE 205, FALLBROOK, CA 92028-3083
(760) 728-6106
(760) 728-4547
Mailing address
521 E ELDER ST, STE 205, FALLBROOK, CA 92028-3083
(760) 728-6106
(760) 728-4547
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G14877
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G148770
—
CA
01
—
YYY49687Y
SOUTHERN BLUE SHIELD
CA
01
—
ZZZ27707Z
NORTHERN BLUE SHIELD
CA
Enumeration date
06/16/2005
Last updated
08/29/2007
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