Individual
MICHAEL P. MCCONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 E VALENCIA MESA DR, SUITE 311, FULLERTON, CA 92835-3813
(714) 446-5180
(714) 446-5181
Mailing address
100 E VALENCIA MESA DR STE 311, FULLERTON, CA 92835-3800
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
A75410
CA
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
A75410
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A754100
—
CA
Enumeration date
02/06/2007
Last updated
11/08/2021
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