Provider Demographics
NPI:1760500011
Name:CANTWELL, MICHAEL FREDRIC (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FREDRIC
Last Name:CANTWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2951 SHASTA RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-2117
Mailing Address - Country:US
Mailing Address - Phone:415-600-3503
Mailing Address - Fax:415-600-1327
Practice Address - Street 1:2300 CALIFORNIA ST
Practice Address - Street 2:SUITE #103
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2753
Practice Address - Country:US
Practice Address - Phone:415-600-3503
Practice Address - Fax:415-600-1327
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG060393208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics