MEDICARE: DR. MICHAEL MARVIN EDELSTEIN M.D.

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	2085R0202X	Diagnostic Radiology Physician	G009107	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000G91070	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1275622094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL MARVIN EDELSTEIN M.D.

Provider Business Mailing Address
First Line	:	3460 RIDGEFORD DR
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-4818
Country	:	US
Telephone Number	:	818-707-9778
Fax Number	:	818-874-3655

Provider Business Practice Location Address
First Line	:	3460 RIDGEFORD DR
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-4818
Country	:	US
Telephone Number	:	818-707-9778
Fax Number	:	818-874-3655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	02/06/2014

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