Provider Demographics
NPI:1982668430
Name:NEEKI, MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NEEKI
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 1:400 N PEPPER AVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1801
Mailing Address - Country:US
Mailing Address - Phone:909-580-6153
Mailing Address - Fax:909-580-1388
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-6153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008138207P00000X
CA20A9117207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114775296Medicaid
OH2534967Medicaid
OHP00241190OtherRR CARE IND # AT STV-ER
MI114812881Medicaid
OH000000377162OtherBC/BS AT ST.CHARLESNONPAR
OH730844OtherBUCKEYE COMMUNITY #
OH000000365492OtherBC/BS INDVIDUAL #ST V-ER
OHP00280659OtherRRCARE # FOR ST. CHARLES
OH000000377162OtherBC/BS AT ST.CHARLESNONPAR
MI114812881Medicaid
OH2534967Medicaid