Provider Demographics
NPI:1184663932
Name:WALDMAN, MICHAEL ADAM (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ADAM
Last Name:WALDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2092 SALT AIR DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3379
Mailing Address - Country:US
Mailing Address - Phone:949-600-8260
Mailing Address - Fax:
Practice Address - Street 1:16100 SAND CANYON AVE
Practice Address - Street 2:250
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3716
Practice Address - Country:US
Practice Address - Phone:949-600-8260
Practice Address - Fax:949-600-8264
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346436342OtherMEDICARE
CA1184663932Other1184663932
CA1346436342OtherMEDICARE