MEDICARE: MANAGEDMED, INC.

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	103TC0700X	Clinical Psychologist	PSY 19483	CA
2	207R00000X	Internal Medicine Physician	A65071	CA
3	207X00000X	Orthopaedic Surgery Physician	A18616	CA
4	103TC0700X	Clinical Psychologist	PSY 7084	CA

General Provider Information

NPI Number	:	1366738676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANAGEDMED, INC.

Provider Business Mailing Address
First Line	:	5455 WILSHIRE BLVD
Second Line	:	SUITE 1903
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4201
Country	:	US
Telephone Number	:	323-934-3861
Fax Number	:

Provider Business Practice Location Address
First Line	:	5455 WILSHIRE BLVD
Second Line	:	SUITE 1903
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4201
Country	:	US
Telephone Number	:	323-934-3861
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. SETH L. HIRSCH
Credential	:	PH.D.
Telephone Number	:	323-934-3861

Provider Enumeration Date	:	06/24/2011
Last Update Date	:	06/24/2011

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Directions to “MANAGEDMED, INC. ” Practice Location

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