Provider Demographics
NPI:1932150315
Name:PULSIPHER, MICHAEL ALLEN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
Last Name:PULSIPHER
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 1:4650 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-2546
Mailing Address - Fax:323-361-8068
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:MAIL STOP #54
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-2546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT357548-1205207R00000X, 207RH0003X, 208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
904OtherUNIVERSITY HEALTH PLANS #
MT0031620Medicaid
ID003038700Medicaid
NM61589039Medicaid
274044OtherDMBA #
AKMD265UTMedicaid
QM0000049131OtherALTIUS #
60365OtherPEHP #
904OtherUNIVERSITY HEALTH PLANS #
F64328Medicare UPIN
NM61589039Medicaid