Provider Demographics
NPI:1992015150
Name:MICHAEL LEE SCHREIBER D O INC
Entity Type:Organization
Organization Name:MICHAEL LEE SCHREIBER D O INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCHREIBER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-453-8393
Mailing Address - Street 1:2400 BROADWAY
Mailing Address - Street 2:SUITE 520-D
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3030
Mailing Address - Country:US
Mailing Address - Phone:310-453-8393
Mailing Address - Fax:310-453-8696
Practice Address - Street 1:2400 BROADWAY
Practice Address - Street 2:SUITE 520-D
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3030
Practice Address - Country:US
Practice Address - Phone:310-453-8393
Practice Address - Fax:310-453-8696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A5391OtherMEDICAL LICENSE