Provider Demographics
NPI:1770859647
Name:RED, MICHAEL L (CATC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:L
Last Name:RED
Suffix:
Gender:M
Credentials:CATC
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Mailing Address - Street 1:637 S VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1305
Mailing Address - Country:US
Mailing Address - Phone:415-293-7320
Mailing Address - Fax:415-626-9188
Practice Address - Street 1:637 SO. VAN NESS AVE.
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-293-7320
Practice Address - Fax:415-626-9188
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility