Provider Demographics
NPI:1679633630
Name:MICHAEL A. STEIN DPM
Entity Type:Organization
Organization Name:MICHAEL A. STEIN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCT REP
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-978-2738
Mailing Address - Street 1:1300 BANCROFT AVE
Mailing Address - Street 2:103
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5147
Mailing Address - Country:US
Mailing Address - Phone:510-483-3390
Mailing Address - Fax:510-394-6402
Practice Address - Street 1:1300 BANCROFT AVE
Practice Address - Street 2:103
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5147
Practice Address - Country:US
Practice Address - Phone:510-483-3390
Practice Address - Fax:510-394-6402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE29050213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00096962OtherRAILROAD MEDICARE
CA000E29051Medicaid
CAT11514Medicare UPIN
CA000E29051Medicaid
CAP00096962OtherRAILROAD MEDICARE