Provider Demographics
NPI:1427078393
Name:KINGSLEY, MICHAEL CHAD (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHAD
Last Name:KINGSLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:887 SANTA CRUZ DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-5364
Mailing Address - Country:US
Mailing Address - Phone:530-529-9729
Mailing Address - Fax:530-229-3703
Practice Address - Street 1:2440 SISTER MARY COLUMBA DR
Practice Address - Street 2:STE 300
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-4356
Practice Address - Country:US
Practice Address - Phone:530-941-6781
Practice Address - Fax:530-229-3703
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H54321Medicare UPIN