Provider Demographics
NPI:1538212741
Name:NORRIS, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:NORRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S. SAN MATEO DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401
Mailing Address - Country:US
Mailing Address - Phone:650-347-7900
Mailing Address - Fax:650-347-7903
Practice Address - Street 1:101 S. SAN MATEO DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401
Practice Address - Country:US
Practice Address - Phone:650-347-7900
Practice Address - Fax:650-347-7903
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00G34340208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G343400Medicaid
CA942592274OtherEIN
CAA45888Medicare UPIN
CA00G3433400Medicare ID - Type Unspecified