=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295042232
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL GITTER M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2010
-----------------------------------------------------
Last Update Date | 09/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2011 WILSHIRE BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057-3503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-413-2700
-----------------------------------------------------
Fax | 213-484-1367
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2011 WILSHIRE BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057-3503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-413-2700
-----------------------------------------------------
Fax | 213-484-1367
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE SECRETARY
-----------------------------------------------------
Name | EVA TORRES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-413-2700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | G20658
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------