Provider Demographics
NPI:1427231018
Name:MICHAEL MARKOPOULOS MD INC
Entity Type:Organization
Organization Name:MICHAEL MARKOPOULOS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-481-0412
Mailing Address - Street 1:2683 VIA DE LA VALLE
Mailing Address - Street 2:SUITE G626
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1911
Mailing Address - Country:US
Mailing Address - Phone:858-481-0412
Mailing Address - Fax:
Practice Address - Street 1:2683 VIA DE LA VALLE
Practice Address - Street 2:SUITE G626
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-1911
Practice Address - Country:US
Practice Address - Phone:858-481-0412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG346870207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G346870Medicaid
CAW7278Medicare PIN
CAA-91621Medicare UPIN