Provider Demographics
NPI:1033401617
Name:MCMICHAEL, CARON ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CARON
Middle Name:ELIZABETH
Last Name:MCMICHAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:16899 W BERNARDO DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1603
Mailing Address - Country:US
Mailing Address - Phone:858-521-2393
Mailing Address - Fax:858-521-2017
Practice Address - Street 1:16899 W BERNARDO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1603
Practice Address - Country:US
Practice Address - Phone:858-521-2393
Practice Address - Fax:858-527-2017
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA104372207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGZ864ZMedicare Oscar/Certification