Provider Demographics
NPI:1598006298
Name:MICHAEL ROBERT SOLOMON M.D., L.AC. PC
Entity Type:Organization
Organization Name:MICHAEL ROBERT SOLOMON M.D., L.AC. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMIEE
Authorized Official - Middle Name:SOLOMON AMIEE WYANT
Authorized Official - Last Name:WYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-416-0042
Mailing Address - Street 1:340 S FARRELL DR
Mailing Address - Street 2:A-110
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7963
Mailing Address - Country:US
Mailing Address - Phone:760-416-0042
Mailing Address - Fax:
Practice Address - Street 1:340 S FARRELL DR
Practice Address - Street 2:A-110
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7963
Practice Address - Country:US
Practice Address - Phone:760-416-0042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81467171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG62972Medicare UPIN