Provider Demographics
NPI:1134123920
Name:MICHALIK, MARCIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:A
Last Name:MICHALIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 N CHINA LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3130
Mailing Address - Country:US
Mailing Address - Phone:760-499-3855
Mailing Address - Fax:760-499-3870
Practice Address - Street 1:1111 N CHINA LAKE BLVD STE 190
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3131
Practice Address - Country:US
Practice Address - Phone:760-499-3855
Practice Address - Fax:760-499-3870
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32768208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G32768OtherIMG
00G327680OtherCOMMERCIAL CARRIERS
CA00G327680Medicaid
00G327680OtherBLUE SHIELD
93555B034OtherTRIWEST/TRICARE
00G327680OtherBLUE CROSS
CA0103OtherJOHN DEERE
0616650001OtherDME
0616650001OtherDME
AM7317945OtherDEA
0616650001OtherDME