MEDICARE: SPECIALIZED PHYSICIANS

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	208800000X	Urology Physician	G81612	CA

General Provider Information

NPI Number	:	1700250362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALIZED PHYSICIANS

Provider Business Mailing Address
First Line	:	8631 W 3RD ST STE 715E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5911
Country	:	US
Telephone Number	:	310-278-8330
Fax Number	:	310-278-7595

Provider Business Practice Location Address
First Line	:	8631 W 3RD ST STE 715E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5911
Country	:	US
Telephone Number	:	310-278-8330
Fax Number	:	310-278-7595

Authorized Official
Title or Position	:	OWNER / PHYSICIAN
Name	:	KIARASH MICHEL
Credential	:	M.D.
Telephone Number	:	310-278-8330

Provider Enumeration Date	:	11/19/2015
Last Update Date	:	11/19/2015

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Directions to “SPECIALIZED PHYSICIANS ” Practice Location

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