Provider Demographics
NPI:1063569655
Name:LIMBERG, MICHAEL BORG (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BORG
Last Name:LIMBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2856
Mailing Address - Country:US
Mailing Address - Phone:805-541-1342
Mailing Address - Fax:805-541-5836
Practice Address - Street 1:1270 PEACH ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2856
Practice Address - Country:US
Practice Address - Phone:805-541-1342
Practice Address - Fax:805-541-5836
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG062604207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G626040Medicaid
CAWG62604FMedicare ID - Type UnspecifiedARROYO GRANDE
CAWG62604IMedicare ID - Type UnspecifiedSANTA MARIA
CA00G626040Medicaid
CAWG62604EMedicare ID - Type UnspecifiedSAN LUIS OBISPO
CAWG62604GMedicare ID - Type UnspecifiedCAMBRIA
CAWG62604HMedicare ID - Type UnspecifiedTEMPLETON