Healthcare Provider Details

I. General information

NPI: 1518716919
Provider Name (Legal Business Name): UZIEL SHEFA MEDICAL SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 FARGO AVE STE 107
SKOKIE IL
60077-3210
US

IV. Provider business mailing address

8200 WILSHIRE BLVD
BEVERLY HILLS CA
90211-2328
US

V. Phone/Fax

Practice location:
  • Phone: 310-933-5688
  • Fax: 310-616-5188
Mailing address:
  • Phone: 310-933-5688
  • Fax: 310-616-5188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ZAZA U ATANELOV
Title or Position: OWNER
Credential: MD
Phone: 310-933-5688