Provider Demographics
NPI:1710190657
Name:STREAMS, MICHAEL L (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:STREAMS
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 1:4900 OVERLAND AVE
Mailing Address - Street 2:259
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4289
Mailing Address - Country:US
Mailing Address - Phone:310-839-9724
Mailing Address - Fax:310-839-9724
Practice Address - Street 1:4900 OVERLAND AVE
Practice Address - Street 2:259
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4289
Practice Address - Country:US
Practice Address - Phone:310-839-9724
Practice Address - Fax:310-839-9724
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34005208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C34005Medicare ID - Type Unspecified
CAA35468Medicare UPIN