Healthcare Provider Details

I. General information

NPI: 1841442290
Provider Name (Legal Business Name): WILLIAM S EIDELMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1654 N CAHUENGA BLVD
LOS ANGELES CA
90028-6202
US

IV. Provider business mailing address

1654 N CAHUENGA BLVD
LOS ANGELES CA
90028-6202
US

V. Phone/Fax

Practice location:
  • Phone: 323-463-3295
  • Fax: 323-463-3740
Mailing address:
  • Phone: 323-463-3295
  • Fax: 323-463-3740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberG32011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: