Provider Demographics
NPI:1235166059
Name:MOSTYN, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MOSTYN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:81767 DR CARREON BLVD
Mailing Address - Street 2:SUITE #201
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5597
Mailing Address - Country:US
Mailing Address - Phone:760-775-4181
Mailing Address - Fax:760-775-4818
Practice Address - Street 1:74990 COUNTRY CLUB DR
Practice Address - Street 2:SUITE # 310
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1991
Practice Address - Country:US
Practice Address - Phone:760-341-8800
Practice Address - Fax:760-775-4818
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-01-25
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Provider Licenses
StateLicense IDTaxonomies
CAA37252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE53744Medicare UPIN