Provider Demographics
NPI:1912101668
Name:MCMICHAEL, JESSICA COLE (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:COLE
Last Name:MCMICHAEL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 508
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-633-2111
Mailing Address - Fax:714-633-5615
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:SUITE 508
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-633-2111
Practice Address - Fax:714-633-5615
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2016-05-03
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Provider Licenses
StateLicense IDTaxonomies
CAA125386207XP3100X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB244893OtherMEDICARE PTAN