Provider Demographics
NPI:1578769923
Name:FEALK, MICHAEL HAROLD (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HAROLD
Last Name:FEALK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GOVERNORS LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-6300
Mailing Address - Country:US
Mailing Address - Phone:530-891-4523
Mailing Address - Fax:530-891-5934
Practice Address - Street 1:2 GOVERNORS LN
Practice Address - Street 2:SUITE A
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-6300
Practice Address - Country:US
Practice Address - Phone:530-891-4523
Practice Address - Fax:530-891-5934
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1419-07208C00000X
CA20A12901208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery