Provider Demographics
NPI:1285186106
Name:MICK S. MEISELMAN, M.D., PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICK S. MEISELMAN, M.D., PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICK
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEISELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-540-2098
Mailing Address - Street 1:1551 BISHOP ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4635
Mailing Address - Country:US
Mailing Address - Phone:805-540-2098
Mailing Address - Fax:805-556-3090
Practice Address - Street 1:1551 BISHOP ST
Practice Address - Street 2:SUITE 230
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4635
Practice Address - Country:US
Practice Address - Phone:805-540-2098
Practice Address - Fax:805-556-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42562207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty