Provider Demographics
NPI:1912978123
Name:NORMAN, MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NORMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19111 TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-8989
Mailing Address - Country:US
Mailing Address - Phone:760-242-7777
Mailing Address - Fax:760-242-2241
Practice Address - Street 1:18523 CORWIN RD STE E
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2300
Practice Address - Country:US
Practice Address - Phone:760-242-1222
Practice Address - Fax:760-242-2241
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6319207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX63190Medicaid
CA00AX63190Medicaid
CA020A63190Medicare ID - Type Unspecified