MEDICARE: DR. BOJAN CERCEK M.D.

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	174400000X	Specialist	A44874	CA
2	207RC0000X	Cardiovascular Disease Physician	A44874	CA

General Provider Information

NPI Number	:	1467413799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOJAN CERCEK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 512717
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90051-0717
Country	:	US
Telephone Number	:	310-967-1884
Fax Number	:	310-967-1744

Provider Business Practice Location Address
First Line	:	8700 BEVERLY BLVD.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-1804
Country	:	US
Telephone Number	:	310-967-1884
Fax Number	:	310-967-1744

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	09/03/2015

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