Provider Demographics
NPI:1124341060
Name:CHIAROTTINO, MICHAEL R (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:CHIAROTTINO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1750 BRIDGEWAY
Mailing Address - Street 2:SUITE B105
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1993
Mailing Address - Country:US
Mailing Address - Phone:415-331-2113
Mailing Address - Fax:415-331-2114
Practice Address - Street 1:1750 BRIDGEWAY
Practice Address - Street 2:SUITE B105
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1993
Practice Address - Country:US
Practice Address - Phone:415-331-2113
Practice Address - Fax:415-331-2114
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-07
Last Update Date:2010-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA#G39528207QA0401X
CAG39528208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine