Provider Demographics
NPI:1700058625
Name:BERNARD A MICHLIN CORP
Entity Type:Organization
Organization Name:BERNARD A MICHLIN CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MICHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-264-2591
Mailing Address - Street 1:3804 NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-3223
Mailing Address - Country:US
Mailing Address - Phone:619-264-2591
Mailing Address - Fax:
Practice Address - Street 1:3804 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-3223
Practice Address - Country:US
Practice Address - Phone:619-264-2591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92437Medicare UPIN