Provider Demographics
NPI:1902944788
Name:GREEN, MICHAEL MCCUTCHEON (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MCCUTCHEON
Last Name:GREEN
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:2720 N HARBOR BLVD
Mailing Address - Street 2:130
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2609
Mailing Address - Country:US
Mailing Address - Phone:714-449-6200
Mailing Address - Fax:714-449-6283
Practice Address - Street 1:2720 N HARBOR BLVD
Practice Address - Street 2:130
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2609
Practice Address - Country:US
Practice Address - Phone:714-449-6200
Practice Address - Fax:714-449-6283
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A4975207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A4975OtherSTATE MEDICAL LICENSE