Provider Demographics
NPI:1073532040
Name:STEIN, MICHAEL A (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:STEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 BANCROFT AVE
Mailing Address - Street 2:103
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5147
Mailing Address - Country:US
Mailing Address - Phone:510-483-3390
Mailing Address - Fax:510-394-6402
Practice Address - Street 1:1300 BANCROFT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5147
Practice Address - Country:US
Practice Address - Phone:510-483-3390
Practice Address - Fax:510-394-6402
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE29050213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E29051Medicaid
CAZZZ25177ZMedicare ID - Type Unspecified
CAT11514Medicare UPIN
CA000E29051Medicaid