Provider Demographics
NPI:1174501845
Name:FAMULARO, MICHAEL A (MD, FACC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:FAMULARO
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 JOHNSON AVE
Mailing Address - Street 2:# 101
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4154
Mailing Address - Country:US
Mailing Address - Phone:805-782-8844
Mailing Address - Fax:805-782-8859
Practice Address - Street 1:1941 JOHNSON AVE
Practice Address - Street 2:# 101
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4154
Practice Address - Country:US
Practice Address - Phone:805-782-8844
Practice Address - Fax:805-782-8859
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29696207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110006126OtherRAILROAD MEDICARE
CAZZZ28458ZOtherBLUES SHIELD
CAGR0068680Medicaid
CAZZZ28458ZOtherBLUES SHIELD
CAA44119Medicare UPIN
CAGR0068680Medicaid
CAWG29696LMedicare PIN
CAWG29696AMedicare PIN
CAWG29696FMedicare PIN
CAWG29696JMedicare PIN
CA110006126OtherRAILROAD MEDICARE
CAWG29696KMedicare PIN