Provider Demographics
NPI:1477634178
Name:RANDALL G. MICHEL, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RANDALL G. MICHEL, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-733-3541
Mailing Address - Street 1:3839 CONSTELLATION RD
Mailing Address - Street 2:STE D
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-1466
Mailing Address - Country:US
Mailing Address - Phone:805-733-3541
Mailing Address - Fax:805-733-0502
Practice Address - Street 1:3839 CONSTELLATION RD
Practice Address - Street 2:STE D
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-1466
Practice Address - Country:US
Practice Address - Phone:805-733-3541
Practice Address - Fax:805-733-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2007-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35715207Y00000X, 207YX0007X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G357150Medicaid
CAA46451Medicare UPIN