Provider Demographics
NPI:1346318821
Name:MICHAEL ROBERT SOLOMON MD LAC PC
Entity Type:Organization
Organization Name:MICHAEL ROBERT SOLOMON MD LAC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-416-0042
Mailing Address - Street 1:340 S FARRELL DR
Mailing Address - Street 2:SUITE A110
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7921
Mailing Address - Country:US
Mailing Address - Phone:760-416-0042
Mailing Address - Fax:760-416-0142
Practice Address - Street 1:340 S FARRELL DR
Practice Address - Street 2:SUITE A110
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7921
Practice Address - Country:US
Practice Address - Phone:760-416-0042
Practice Address - Fax:760-416-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81467208D00000X
LAMD10726R208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherBLUE CROSS
CA=========OtherBLUE CROSS
00G814670Medicare ID - Type Unspecified