Provider Demographics
NPI:1083779359
Name:SOLLOD, MITCHELL C (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:C
Last Name:SOLLOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:595 BUCKINGHAM WAY
Mailing Address - Street 2:#355
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1909
Mailing Address - Country:US
Mailing Address - Phone:415-566-2727
Mailing Address - Fax:415-566-0081
Practice Address - Street 1:595 BUCKINGHAM WAY
Practice Address - Street 2:#355
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1909
Practice Address - Country:US
Practice Address - Phone:415-566-2727
Practice Address - Fax:415-566-0081
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC27394207KA0200X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C273940Medicaid
943234237OtherFEDERAL TAX IDENT NUMBER
CA00C273940Medicaid