Provider Demographics
NPI:1629371976
Name:DR MIKEL WALK IN CLINIC
Entity Type:Organization
Organization Name:DR MIKEL WALK IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-221-9298
Mailing Address - Street 1:15791 BEAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1746
Mailing Address - Country:US
Mailing Address - Phone:760-949-1231
Mailing Address - Fax:760-949-1236
Practice Address - Street 1:11336 BARTLETT AVE
Practice Address - Street 2:STE 12
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-1948
Practice Address - Country:US
Practice Address - Phone:760-530-1635
Practice Address - Fax:760-949-1236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR MIKEL WALK IN CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48518208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty