MEDICARE: MIKO ANESTHESIA GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1255727541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIKO ANESTHESIA GROUP

Provider Business Mailing Address
First Line	:	435 N ROXBURY DR STE 205
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5004
Country	:	US
Telephone Number	:	310-275-2705
Fax Number	:	310-275-2701

Provider Business Practice Location Address
First Line	:	435 N ROXBURY DR STE 205
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5004
Country	:	US
Telephone Number	:	310-275-2705
Fax Number	:	310-275-2701

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MICHAEL K OBENG
Credential	:	MD
Telephone Number	:	310-275-2705

Provider Enumeration Date	:	04/13/2015
Last Update Date	:	04/13/2015

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Directions to “MIKO ANESTHESIA GROUP ” Practice Location

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