Provider Demographics
NPI:1528463908
Name:BLYTH, MICHAEL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:BLYTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:24422 AVENIDA DE LA CARLOTA STE 300
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3628
Mailing Address - Country:US
Mailing Address - Phone:949-599-2434
Mailing Address - Fax:949-599-2430
Practice Address - Street 1:1215 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2107
Practice Address - Country:US
Practice Address - Phone:661-663-4700
Practice Address - Fax:661-489-3338
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2022-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101256381208000000X
CAG58537208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics