Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Michael Keith Mietz, PA

Individual provider Medical Physician Assistant · NPI 1689944779

Michael Keith Mietz, PA is a Physician Assistant in Lakeport, California. Qualified in 2011, 15 years ago. Practices with Lake County Tribal Health Consortium Inc, a 42-clinician group and works from 2 locations. Licensed in California and New York.

Years since qualifying
15
Licensed in
CA, NY
In the registry since
2012
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

925 Bevins Ct
Lakeport, CA 95453-9754
Phone: (707) 263-8383
Fax: (707) 263-5019
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 14440 Olympic Drive, Clearlake, CA 95422-8809 — (707) 263-8383

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA52485 (CA)
Physician Assistant Taxonomy 363A00000X · Licence 015421 (NY)

Record details

NPI number1689944779
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJanuary 5, 2012
Last updated in NPPESOctober 31, 2024
Certification dateOctober 31, 2024
Mailing address925 Bevins Court, Lakeport, CA 95453-9754

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Lake County Tribal Health Consortium Inc — 42 clinicians
Accepts Medicare assignment Not indicated

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