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General NPI Number Information
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NPI Number | 1205658556
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Entity Type | Organization
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Legal Business Name | MACYSZYN MD, INC.
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 4553 GLENCOE AVE STE 140
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City | MARINA DEL REY
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State | CA
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Zip | 90292-7906
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Country | US
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Telephone | 424-835-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 4551 GLENCOE AVE STE 145
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6385
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Country | US
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Telephone | 424-835-3100
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Fax |
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Authorized Official
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Title or Position | NEUROSURGEON
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Name | LUKE MACYSZYN
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Credential | MD
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Telephone | 727-742-4292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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