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General NPI Number Information
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NPI Number | 1427109388
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Entity Type | Organization
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Legal Business Name | MAGED S MIKHAIL A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 05/11/2009
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Provider Practice Location Address
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Address Line | 18425 BURBANK BLVD. SUITE #102
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City | TARZANA
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State | CA
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Zip | 91356-2806
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Country | US
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Telephone | 818-654-0520
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Fax | 818-654-0596
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Provider Business Mailing Address
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Address Line | 18425 BURBANK BLVD SUITE #102
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City | TARZANA
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State | CA
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Zip | 91356-2806
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Country | US
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Telephone | 818-654-0520
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Fax | 818-654-0596
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAGED S. MIKHAIL
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Credential | M.D.
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Telephone | 818-654-0520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G45367
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License Number State | CA
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