MEDICARE: SOBOL ORTHOPEDIC MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	G42254

General Provider Information

NPI Number	:	1073636817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOBOL ORTHOPEDIC MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	8618 S SEPULVEDA BLVD
Second Line	:	SUITE 130
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4005
Country	:	US
Telephone Number	:	310-649-5894
Fax Number	:	310-649-5898

Provider Business Practice Location Address
First Line	:	8618 S SEPULVEDA BLVD
Second Line	:	STE. 130
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4005
Country	:	US
Telephone Number	:	310-649-5894
Fax Number	:	310-649-1094

Authorized Official
Title or Position	:	OWNER
Name	:	PHILIP A SOBOL
Credential	:	MD
Telephone Number	:	310-649-5894

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	01/28/2013

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