Provider Demographics
NPI:1306069679
Name:REYADH J MICHAIL MD INC
Entity type:Organization
Organization Name:REYADH J MICHAIL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REYADH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MICHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-787-1049
Mailing Address - Street 1:14860 ROSCOE BLVD
Mailing Address - Street 2:SUITE #201
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4665
Mailing Address - Country:US
Mailing Address - Phone:818-787-1049
Mailing Address - Fax:818-787-1129
Practice Address - Street 1:14860 ROSCOE BLVD
Practice Address - Street 2:SUITE #201
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4665
Practice Address - Country:US
Practice Address - Phone:818-787-1049
Practice Address - Fax:818-787-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA4179102083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50475Medicare UPIN