Provider Demographics
NPI:1033137427
Name:MCGAVIC, MICHAEL DARIN (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DARIN
Last Name:MCGAVIC
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13132 STUDEBAKER RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2559
Mailing Address - Country:US
Mailing Address - Phone:562-651-1111
Mailing Address - Fax:562-651-1131
Practice Address - Street 1:13132 STUDEBAKER RD STE 2
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2559
Practice Address - Country:US
Practice Address - Phone:562-651-1111
Practice Address - Fax:562-651-1131
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4048213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E40480Medicaid
CAU66327Medicare UPIN
CA000E40480Medicaid