Provider Demographics
NPI:1134269715
Name:R MICHAEL CONTRO MD A PROFESSIONAL CORP
Entity type:Organization
Organization Name:R MICHAEL CONTRO MD A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CONTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-356-5111
Mailing Address - Street 1:15251 NATIONAL AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2400
Mailing Address - Country:US
Mailing Address - Phone:408-356-5111
Mailing Address - Fax:408-356-0654
Practice Address - Street 1:15251 NATIONAL AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2400
Practice Address - Country:US
Practice Address - Phone:408-356-5111
Practice Address - Fax:408-356-0654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG034942174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G349420Medicare PIN
CAA46158Medicare UPIN