Michael Keith Mietz, PA
Physician Assistant, Medical in Lakeport, CA. Individual provider (NPI-1).
NPI number1689944779
StatusActive
Last updated in NPPESOct 31, 2024
Details
- NPI
- 1689944779
- Entity type
- Individual (NPI-1)
- Name
- Michael Keith Mietz
- Credential
- PA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 5, 2012
- Certification date
- Oct 31, 2024
- Last updated
- Oct 31, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | PA52485 | CA | Yes |
| 363A00000X | Physician Assistant | 015421 | NY |
Practice location
925 Bevins CourtLakeport, CA 95453-9754
Phone 707-263-8383 · Fax 707-263-5019
Mailing address
925 Bevins CourtLakeport, CA 95453-9754
Phone 707-263-8383 · Fax 707-263-5019
Other practice locations
14440 Olympic Drive
Clearlake, CA 95422-8809
Clearlake, CA 95422-8809
Phone 707-263-8383 · Fax 707-263-5019
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