Provider Demographics
NPI:1427053438
Name:MICHAELIAN, MELVYN J (MD)
Entity type:Individual
Prefix:DR
First Name:MELVYN
Middle Name:J
Last Name:MICHAELIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:521 E ELDER ST
Mailing Address - Street 2:STE 205
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3083
Mailing Address - Country:US
Mailing Address - Phone:760-728-6106
Mailing Address - Fax:760-728-4547
Practice Address - Street 1:521 E ELDER ST
Practice Address - Street 2:STE 205
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3083
Practice Address - Country:US
Practice Address - Phone:760-728-6106
Practice Address - Fax:760-728-4547
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG14877208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY49687YOtherSOUTHERN BLUE SHIELD
CAZZZ27707ZOtherNORTHERN BLUE SHIELD
CA00G148770Medicaid
CAA39363Medicare UPIN
CAYYY49687YOtherSOUTHERN BLUE SHIELD
CA00G148770Medicare ID - Type UnspecifiedNORTHERN NHIC MEDICARE