Provider Demographics
NPI:1477549970
Name:DRUCKER, MICHAEL RICHARD (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:DRUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2876 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1550
Mailing Address - Country:US
Mailing Address - Phone:805-526-9242
Mailing Address - Fax:805-526-3768
Practice Address - Street 1:2876 SYCAMORE DR
Practice Address - Street 2:SUITE 304
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1550
Practice Address - Country:US
Practice Address - Phone:805-526-9242
Practice Address - Fax:805-526-3768
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29256174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43997Medicare UPIN