Provider Demographics
NPI:1457859407
Name:DR. J. MICHAIL INC.
Entity Type:Organization
Organization Name:DR. J. MICHAIL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-787-1049
Mailing Address - Street 1:14860 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4665
Mailing Address - Country:US
Mailing Address - Phone:818-787-1049
Mailing Address - Fax:
Practice Address - Street 1:10515 BALBOA BLVD STE 290
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6362
Practice Address - Country:US
Practice Address - Phone:818-831-8999
Practice Address - Fax:818-831-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA142997207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty