MEDICARE: DR. STEVEN MARCUS 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	261QP2300X	Primary Care Clinic/Center	G33630	CA

General Provider Information

NPI Number	:	1407098015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN MARCUS M.D.

Provider Business Mailing Address
First Line	:	1021 MANNING AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3220
Country	:	US
Telephone Number	:	310-474-5671
Fax Number	:	310-474-3985

Provider Business Practice Location Address
First Line	:	1021 MANNING AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3220
Country	:	US
Telephone Number	:	310-474-5671
Fax Number	:	310-474-3985

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

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	03/27/2009

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