Provider Demographics
NPI:1609804657
Name:ANDREW J. MIKAELIAN, M.D. INC.
Entity Type:Organization
Organization Name:ANDREW J. MIKAELIAN, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIKAELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-494-9993
Mailing Address - Street 1:1240 WESTLAKE BLVD.
Mailing Address - Street 2:SUITE 135
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1240 WESTLAKE BLVD.
Practice Address - Street 2:SUITE 135
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1987
Practice Address - Country:US
Practice Address - Phone:805-494-9993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W20228Medicare PIN