Provider Demographics
NPI:1710143326
Name:FUCHS, MICHAEL IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:IAN
Last Name:FUCHS
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 1:2021 SANTA MONICA BLVD STE 245E
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2132
Mailing Address - Country:US
Mailing Address - Phone:310-453-1324
Mailing Address - Fax:424-212-5921
Practice Address - Street 1:2021 SANTA MONICA BLVD STE 245E
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2132
Practice Address - Country:US
Practice Address - Phone:310-829-0199
Practice Address - Fax:424-212-5921
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15309207R00000X
CAG178866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine