Provider Demographics
NPI:1750464111
Name:SEDRAK, MICHAEL FAYEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FAYEZ
Last Name:SEDRAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1902 FULLERTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3112
Mailing Address - Country:US
Mailing Address - Phone:951-479-8994
Mailing Address - Fax:619-209-7888
Practice Address - Street 1:1902 FULLERTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3112
Practice Address - Country:US
Practice Address - Phone:951-479-8994
Practice Address - Fax:619-209-7888
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82582208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BQ372VMedicare PIN