Provider Demographics
NPI:1861575300
Name:HEBRARD, MICHAEL EDWIN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWIN
Last Name:HEBRARD
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 1:300 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4826
Mailing Address - Country:US
Mailing Address - Phone:510-465-3668
Mailing Address - Fax:510-465-1332
Practice Address - Street 1:300 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4826
Practice Address - Country:US
Practice Address - Phone:510-465-3668
Practice Address - Fax:510-465-1332
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA645382081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH25650Medicare UPIN
CAZZZ24068ZMedicare PIN