MEDICARE: LUCIAN MAIDAN 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	2084D0003X	Diagnostic Neuroimaging (Psychiatry & Neurology) Physician	A55183	CA
2	2084V0102X	Vascular Neurology Physician	A55183	CA
3	2084N0400X	Neurology Physician	A55183	CA

General Provider Information

NPI Number	:	1518959097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCIAN MAIDAN M.D.

Provider Business Mailing Address
First Line	:	3000 Q ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-7058
Country	:	US
Telephone Number	:	916-733-5779
Fax Number	:	916-733-5743

Provider Business Practice Location Address
First Line	:	3000 Q ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-7058
Country	:	US
Telephone Number	:	916-733-5779
Fax Number	:	916-733-5743

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	09/09/2012

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