MEDICARE: MILO M WEBBER M D, 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	174400000X	Specialist	A16893	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A16893	OTHER	CA	MEDICAL PROVIDER NUMBER

General Provider Information

NPI Number	:	1982616793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILO M WEBBER M D, INC

Provider Business Mailing Address
First Line	:	5205 S SHERBOURNE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90056-1127
Country	:	US
Telephone Number	:	310-338-0659
Fax Number	:	310-338-0659

Provider Business Practice Location Address
First Line	:	3631 CRENSHAW BLVD
Second Line	:	SUITE 103
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4869
Country	:	US
Telephone Number	:	323-730-5600
Fax Number	:	323-730-5603

Authorized Official
Title or Position	:	CEO
Name	:	DR. MILO MELVIN WEBBER
Credential	:	MD
Telephone Number	:	310-338-0659

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	09/06/2023

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