Healthcare Provider Details

I. General information

NPI: 1124343959
Provider Name (Legal Business Name): TISHUK GLOBAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9595 WILSHIRE BLVD SUITE 900
BEVERLY HILLS CA
90212-2512
US

IV. Provider business mailing address

9595 WILSHIRE BLVD SUITE 900
BEVERLY HILLS CA
90212-2512
US

V. Phone/Fax

Practice location:
  • Phone: 888-614-7772
  • Fax: 818-479-9443
Mailing address:
  • Phone: 888-614-7772
  • Fax: 818-479-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN TISHUK
Title or Position: PRESIDENT
Credential:
Phone: 888-614-7772