Provider Demographics
NPI:1184670820
Name:MICHEL, LESLIE B (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:B
Last Name:MICHEL
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 1:805 AEROVISTA PL
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7919
Mailing Address - Country:US
Mailing Address - Phone:805-594-1240
Mailing Address - Fax:805-594-1241
Practice Address - Street 1:805 AEROVISTA PL
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7919
Practice Address - Country:US
Practice Address - Phone:805-594-1240
Practice Address - Fax:805-594-1241
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22925207R00000X
CAA108368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1083680OtherBLUE SHIELD PIN
CAA108368OtherMEDICAL LICENSE
CA7623803OtherAETNA
CA0A1083680OtherBLUE SHIELD PIN
CAA108368OtherMEDICAL LICENSE