Provider Demographics
NPI:1356428205
Name:INSERRA, MICHELLE M (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:INSERRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3071 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4054
Mailing Address - Country:US
Mailing Address - Phone:408-540-5400
Mailing Address - Fax:408-540-5419
Practice Address - Street 1:3071 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4054
Practice Address - Country:US
Practice Address - Phone:408-540-5400
Practice Address - Fax:408-540-5419
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73027207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A730270Medicaid
I07771Medicare UPIN
CA00A730270Medicaid