Provider Demographics
NPI:1609808765
Name:DILLINGHAM, MICHAEL F (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:DILLINGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:500 ARGUELLO ST
Mailing Address - Street 2:#100
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063
Mailing Address - Country:US
Mailing Address - Phone:650-851-4900
Mailing Address - Fax:650-995-1202
Practice Address - Street 1:500 ARGUELL ST
Practice Address - Street 2:#100
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-851-4900
Practice Address - Fax:650-995-1202
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23134207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A41867Medicare UPIN