Provider Demographics
NPI:1942217021
Name:SHABTAI, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SHABTAI
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 1:17075 DEVONSHIRE ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1600
Mailing Address - Country:US
Mailing Address - Phone:818-435-4789
Mailing Address - Fax:818-363-5454
Practice Address - Street 1:17075 DEVONSHIRE ST
Practice Address - Street 2:SUITE 107
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1600
Practice Address - Country:US
Practice Address - Phone:818-435-4789
Practice Address - Fax:818-363-5454
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91300208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACR435YMedicare UPIN
CAI59290Medicare UPIN
CAA91300Medicare ID - Type Unspecified