Provider Demographics
NPI:1396756847
Name:PAVELOFF, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:PAVELOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 9819
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-9819
Mailing Address - Country:US
Mailing Address - Phone:805-682-4459
Mailing Address - Fax:
Practice Address - Street 1:1933 CLIFF DRIVE
Practice Address - Street 2:29
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93109
Practice Address - Country:US
Practice Address - Phone:805-682-4459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78490207W00000X, 332B00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4557534OtherAETNA
CAF81024Medicare UPIN
CA4557534OtherAETNA
CA4469950002Medicare NSC