Provider Demographics
NPI:1194027854
Name:DR MIKEL WALK IN CLINIC
Entity Type:Organization
Organization Name:DR MIKEL WALK IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-221-9298
Mailing Address - Street 1:15791 BEAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1746
Mailing Address - Country:US
Mailing Address - Phone:760-949-1231
Mailing Address - Fax:760-949-1236
Practice Address - Street 1:20258 US HIGHWAY 18
Practice Address - Street 2:STE 450
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-6197
Practice Address - Country:US
Practice Address - Phone:760-961-8125
Practice Address - Fax:760-949-1236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR MIKEL WALK IN CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48518208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty