Healthcare Provider Details

I. General information

NPI: 1053869966
Provider Name (Legal Business Name): MIDTOWN EMERGENCY PHYSICIANS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E ALMOND AVE
MADERA CA
93637-5606
US

IV. Provider business mailing address

PO BOX 5026
SAN DIMAS CA
91773-9126
US

V. Phone/Fax

Practice location:
  • Phone: 559-675-5555
  • Fax:
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-623-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: STEVEN P. MARON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 925-255-5837