Provider Demographics
NPI:1053456608
Name:ERLICH, MICHAEL ALAN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
Last Name:ERLICH
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 1:3650 E SOUTH STREET
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1502
Mailing Address - Country:US
Mailing Address - Phone:562-633-1007
Mailing Address - Fax:562-633-6427
Practice Address - Street 1:3650 E SOUTH STREET
Practice Address - Street 2:SUITE 108
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1502
Practice Address - Country:US
Practice Address - Phone:562-633-1007
Practice Address - Fax:562-633-6427
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG238882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G238880Medicaid
G23888OtherMED LIC
A90846Medicare UPIN
G23888OtherMED LIC
WG23888DMedicare ID - Type Unspecified