MEDICARE: G & M MANAGEMENT LLC

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	2471S1302X	Sonography Radiologic Technologist

General Provider Information

NPI Number	:	1679741110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G & M MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	3566 BEVERLY GLEN BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-4437
Country	:	US
Telephone Number	:	323-653-7566
Fax Number	:	323-653-5784

Provider Business Practice Location Address
First Line	:	3566 BEVERLY GLEN BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-4437
Country	:	US
Telephone Number	:	323-653-7566
Fax Number	:	323-653-5784

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GENNADY TIKHONOV
Credential	:
Telephone Number	:	323-653-7566

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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Directions to “G & M MANAGEMENT LLC ” Practice Location

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