Healthcare Provider Details

I. General information

NPI: 1629016894
Provider Name (Legal Business Name): MICHAEL J GUREVITCH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CONGRESS ST SUITE 201
PASADENA CA
91105-3024
US

IV. Provider business mailing address

10 CONGRESS ST STE 155
PASADENA CA
91105-3045
US

V. Phone/Fax

Practice location:
  • Phone: 626-486-0187
  • Fax:
Mailing address:
  • Phone: 626-486-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG50403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: