Provider Demographics
NPI:1376767723
Name:VERCILLO, MICHAEL T (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:VERCILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:375 ROLLING OAKS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1023
Mailing Address - Country:US
Mailing Address - Phone:805-497-9481
Mailing Address - Fax:805-497-3416
Practice Address - Street 1:375 ROLLING OAKS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1023
Practice Address - Country:US
Practice Address - Phone:805-497-9481
Practice Address - Fax:805-497-3416
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2012-05-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ40629207X00000X
CAA85526207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery