Provider Demographics
NPI:1659344232
Name:GELLER, MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21840 NORMANDIE AVE
Mailing Address - Street 2:STE. 700
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2047
Mailing Address - Country:US
Mailing Address - Phone:310-222-5101
Mailing Address - Fax:310-320-5463
Practice Address - Street 1:21840 NORMANDIE AVE
Practice Address - Street 2:STE. 700
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2047
Practice Address - Country:US
Practice Address - Phone:310-222-5101
Practice Address - Fax:310-320-5463
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79993208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A799930Medicaid
CAWA79993AMedicare ID - Type UnspecifiedPPIN
CACJ494ZMedicare PIN
CAWA79993BMedicare PIN
CAWA79993CMedicare PIN
CAWA79993CMedicare ID - Type UnspecifiedPPIN
CA00A799930Medicaid
CAH17264Medicare UPIN
CAWA79993AMedicare PIN