Provider Demographics
NPI:1114023850
Name:NORRIS, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NORRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2888 LONG BEACH BLVD
Mailing Address - Street 2:SUITE #340
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1530
Mailing Address - Country:US
Mailing Address - Phone:562-595-6891
Mailing Address - Fax:562-490-7271
Practice Address - Street 1:2888 LONG BEACH BLVD
Practice Address - Street 2:SUITE #340
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1530
Practice Address - Country:US
Practice Address - Phone:562-595-6891
Practice Address - Fax:562-490-7271
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG20625208800000X, 2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ75909ZMedicaid
CAW2431Medicare ID - Type Unspecified
CAZZZ75909ZMedicaid