Provider Demographics
NPI:1528009842
Name:AGRON, MICHAEL SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SAMUEL
Last Name:AGRON
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 1:583 N ALTA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-1630
Mailing Address - Country:US
Mailing Address - Phone:626-445-5082
Mailing Address - Fax:
Practice Address - Street 1:9080 COLIMA RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1600
Practice Address - Country:US
Practice Address - Phone:562-907-1565
Practice Address - Fax:562-907-1585
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37045207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C370450Medicaid
CAWC37045EMedicare PIN
CAE68009Medicare UPIN
CAWC37045CMedicare PIN
CAWC37045AMedicare PIN
CAWC37045FMedicare PIN
CAWC37045Medicare ID - Type Unspecified
CAWC37045BMedicare PIN
CAWC37045DMedicare PIN