Provider Demographics
NPI:1861506941
Name:MIKHAIL, PETER NABIL (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:NABIL
Last Name:MIKHAIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4008
Mailing Address - Country:US
Mailing Address - Phone:310-642-0100
Mailing Address - Fax:310-674-2983
Practice Address - Street 1:8610 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4008
Practice Address - Country:US
Practice Address - Phone:310-642-0100
Practice Address - Fax:310-674-2983
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2OA9152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine