Provider Demographics
NPI:1023065760
Name:LENOIR, MICHAEL ANDRE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDRE
Last Name:LENOIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7677 OAKPORT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-1961
Mailing Address - Country:US
Mailing Address - Phone:510-993-0200
Mailing Address - Fax:510-922-9224
Practice Address - Street 1:3448 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1422
Practice Address - Country:US
Practice Address - Phone:510-373-3000
Practice Address - Fax:844-965-9795
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC331360207R00000X, 208000000X
CAC33136207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOC13360Medicaid
CAOOC13360Medicaid
CAA35175Medicare ID - Type Unspecified