Healthcare Provider Details

I. General information

NPI: 1346211794
Provider Name (Legal Business Name): JOEL D MITTLEMAN M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8641 WILSHIRE BLVD STE 300
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

8641 WILSHIRE BLVD STE 300
BEVERLY HILLS CA
90211-2921
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-9162
  • Fax: 310-854-7259
Mailing address:
  • Phone: 310-652-9162
  • Fax: 310-854-7259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG28634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: