MEDICARE: COMPREHENSIVE UROLOGY MEDICAL 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	208800000X	Urology Physician		CA

General Provider Information

NPI Number	:	1538138946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE UROLOGY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	8631 W 3RD ST
Second Line	:	STE 715 EAST
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5901
Country	:	US
Telephone Number	:	310-278-8330
Fax Number	:	310-278-7595

Provider Business Practice Location Address
First Line	:	8631 W 3RD ST
Second Line	:	STE 715 EAST
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5901
Country	:	US
Telephone Number	:	310-278-8330
Fax Number	:	310-278-7595

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. KIARASH NMN MICHEL
Credential	:	M.D.
Telephone Number	:	310-278-8330

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	08/22/2020

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