Provider Demographics
NPI:1558695064
Name:MICHAEL A AMSTER, MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL A AMSTER, MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-322-3301
Mailing Address - Street 1:1101 B GALE WILSON BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3700
Mailing Address - Country:US
Mailing Address - Phone:707-429-7766
Mailing Address - Fax:707-429-6980
Practice Address - Street 1:1101 B GALE WILSON BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3700
Practice Address - Country:US
Practice Address - Phone:707-429-7766
Practice Address - Fax:707-429-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty