Provider Demographics
NPI:1770543712
Name:CARPENTER, MICHELE M (MD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:CARPENTER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W LAVETA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4305
Mailing Address - Country:US
Mailing Address - Phone:714-734-6216
Mailing Address - Fax:888-424-9767
Practice Address - Street 1:1010 W LA VETA AVE
Practice Address - Street 2:SUITE 470
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-565-0166
Practice Address - Fax:714-937-0166
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG587552086X0206X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10689Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER