Provider Demographics
NPI:1689761157
Name:BISHAI, MICHAEL B (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:BISHAI
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 1:112 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1710
Mailing Address - Country:US
Mailing Address - Phone:626-796-8102
Mailing Address - Fax:626-796-8060
Practice Address - Street 1:112 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1710
Practice Address - Country:US
Practice Address - Phone:626-796-8102
Practice Address - Fax:626-796-8060
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA342822088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA340004152OtherRAILROAD MEDICARE
CAW5818OtherGROUP PTAN
CA340004152OtherRAILROAD MEDICARE
CAA84602Medicare UPIN