Provider Demographics
NPI:1033422142
Name:MICHAS-MARTIN, PETER ANDREAS (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANDREAS
Last Name:MICHAS-MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:ANDREAS
Other - Last Name:MICHAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93902-0480
Mailing Address - Country:US
Mailing Address - Phone:831-718-9701
Mailing Address - Fax:
Practice Address - Street 1:275 CROSSROADS BLVD
Practice Address - Street 2:A
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8684
Practice Address - Country:US
Practice Address - Phone:831-718-9701
Practice Address - Fax:831-886-1529
Is Sole Proprietor?:No
Enumeration Date:2010-07-17
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.00532092084N0400X
CAA1353682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program