Provider Demographics
NPI:1154357564
Name:LOCK, MICHAEL M (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:LOCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4822 TOCALOMA LN
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1666
Mailing Address - Country:US
Mailing Address - Phone:818-952-1082
Mailing Address - Fax:
Practice Address - Street 1:27800 MEDICAL CENTER RD
Practice Address - Street 2:SUITE 160
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6410
Practice Address - Country:US
Practice Address - Phone:949-364-9120
Practice Address - Fax:949-364-8465
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG497092085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G497090Medicaid
CA00G497090Medicaid