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General NPI Number Information
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NPI Number | 1932268968
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Entity Type | Organization
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Legal Business Name | SHERMAN OAKS MEDICAL GRP INC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | 4529 SHERMAN OAKS AVENUE
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3820
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Country | US
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Telephone | 818-986-8193
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Fax | 818-986-7133
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Provider Business Mailing Address
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Address Line | 4529 SHERMAN OAKS AVENUE
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3820
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Country | US
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Telephone | 818-986-8193
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Fax | 818-986-7133
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL A KIRSCH
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Credential | MD
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Telephone | 818-986-8193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G38404
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G12156
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License Number State | CA
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