Provider Demographics
NPI:1093711806
Name:FANGMAN, MICHAEL P (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:FANGMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O BOX 62106
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93160-2106
Mailing Address - Country:US
Mailing Address - Phone:805-681-1761
Mailing Address - Fax:805-681-1768
Practice Address - Street 1:2040 VIBORG RD
Practice Address - Street 2:SUITE 140
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2272
Practice Address - Country:US
Practice Address - Phone:805-681-1761
Practice Address - Fax:805-681-1768
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG27775207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAER692ZMedicare PIN