Provider Demographics
NPI:1588698112
Name:ALPER, MIKHAIL (PA)
Entity type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:
Last Name:ALPER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 E ALMOND AVE # ST103
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5562
Mailing Address - Country:US
Mailing Address - Phone:559-673-4000
Mailing Address - Fax:559-673-3661
Practice Address - Street 1:451 E ALMOND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5562
Practice Address - Country:US
Practice Address - Phone:559-673-4000
Practice Address - Fax:559-673-3661
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA158560363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA158560Medicare ID - Type Unspecified