Provider Demographics
NPI:1730314063
Name:MITRI, MICHAEL SQUIERS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SQUIERS
Last Name:MITRI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:625 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2613
Mailing Address - Country:US
Mailing Address - Phone:626-304-2626
Mailing Address - Fax:626-585-0695
Practice Address - Street 1:625 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2613
Practice Address - Country:US
Practice Address - Phone:626-304-2626
Practice Address - Fax:626-585-0695
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2013-09-10
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Provider Licenses
StateLicense IDTaxonomies
CAA124527207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology