Provider Demographics
NPI:1629101191
Name:GALES, MICHAEL ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ARTHUR
Last Name:GALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11847 WILSHIRE BLVD
Mailing Address - Street 2:STE 303
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6620
Mailing Address - Country:US
Mailing Address - Phone:310-473-2788
Mailing Address - Fax:310-917-9143
Practice Address - Street 1:11847 WILSHIRE BLVD
Practice Address - Street 2:STE 303
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6620
Practice Address - Country:US
Practice Address - Phone:310-473-2788
Practice Address - Fax:310-917-9143
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG328102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG32810Medicare PIN
CAG32810Medicare ID - Type Unspecified
CAA45298Medicare UPIN