Provider Demographics
NPI:1922024942
Name:ARATA, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:ARATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9442
Mailing Address - Country:US
Mailing Address - Phone:949-247-8877
Mailing Address - Fax:949-247-8878
Practice Address - Street 1:12500 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6393
Practice Address - Country:US
Practice Address - Phone:240-964-1036
Practice Address - Fax:240-964-1048
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA709672085R0204X, 2085R0202X
MDD00862832085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH20460Medicare UPIN
CAWA70967NMedicare PIN
CAA70967Medicare ID - Type Unspecified
CABJ960YMedicare PIN
CAWA70967PMedicare PIN
CAWA70967OMedicare PIN