Organization Name: | MICHAEL M. FANOUS, D.P.M., INC. |
NPI Number: | 1083796726 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL M. FANOUS (PRESIDENT) |
Mailing Address: | 15366 11th St Suite D Victorville |
State: | CA US |
Postal Code: | 923953726 |
Phone Number: | 7609511238 |
Fax Number: | |
NPI Enumeration Date: | 10/20/2006 |
NPI Last Update Date: | 07/31/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | E3544 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |