Provider Demographics
NPI:1225062623
Name:MICHEL, RANDALL GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:GEORGE
Last Name:MICHEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 N THIRD ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7002
Mailing Address - Country:US
Mailing Address - Phone:805-736-1253
Mailing Address - Fax:805-736-3193
Practice Address - Street 1:136 N THIRD ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7002
Practice Address - Country:US
Practice Address - Phone:805-736-1253
Practice Address - Fax:805-736-3193
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35715207Y00000X, 207YX0007X, 207YX0905X
NC17690207Y00000X, 207YX0007X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G357150Medicaid
CA00G357150Medicaid