Provider Demographics
NPI:1457560153
Name:CREAMER, MICHAEL COLLIER (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:COLLIER
Last Name:CREAMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 HAVERFORD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-4379
Mailing Address - Country:US
Mailing Address - Phone:310-459-5910
Mailing Address - Fax:
Practice Address - Street 1:849 W 34TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0079
Practice Address - Country:US
Practice Address - Phone:213-740-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11683363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant