Provider Demographics
NPI:1386977551
Name:MICHAEL J EILBERT M.D, INC
Entity type:Organization
Organization Name:MICHAEL J EILBERT M.D, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:EILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-770-0600
Mailing Address - Street 1:PO BOX 3661
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-8661
Mailing Address - Country:US
Mailing Address - Phone:949-770-0600
Mailing Address - Fax:877-734-0309
Practice Address - Street 1:24012 CALLE DE LA PLATA
Practice Address - Street 2:SUITE 350
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3621
Practice Address - Country:US
Practice Address - Phone:949-770-0600
Practice Address - Fax:877-734-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACK550AMedicare PIN
CACK549ZMedicare PIN