Provider Demographics
NPI:1245262948
Name:PRADO, MICHAEL STEPHEN (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:PRADO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 E 1ST AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3547
Mailing Address - Country:US
Mailing Address - Phone:530-342-5621
Mailing Address - Fax:530-342-5636
Practice Address - Street 1:676 E 1ST AVE STE 9
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3547
Practice Address - Country:US
Practice Address - Phone:530-342-5621
Practice Address - Fax:530-342-5636
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE 1166213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10803Medicare UPIN
CA000E11662Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER