Provider Demographics
NPI:1669471603
Name:KAMIEL, MICHAEL B (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:KAMIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E STE 1207
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2015
Mailing Address - Country:US
Mailing Address - Phone:310-559-3663
Mailing Address - Fax:310-559-3221
Practice Address - Street 1:2080 CENTURY PARK E STE 1207
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2015
Practice Address - Country:US
Practice Address - Phone:310-559-3663
Practice Address - Fax:310-559-3221
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24597174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G245970Medicaid
CAA42310Medicare UPIN
CA00G245970Medicaid