Provider Demographics
NPI:1952909004
Name:OPENSHAW, MICHAEL (CPO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:OPENSHAW
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 W REDLANDS BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-3127
Mailing Address - Country:US
Mailing Address - Phone:909-798-5853
Mailing Address - Fax:909-798-0602
Practice Address - Street 1:1849 W REDLANDS BLVD STE 103
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3127
Practice Address - Country:US
Practice Address - Phone:909-798-5853
Practice Address - Fax:909-798-0602
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist