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NPI Code Detail

MEDICARE: VITAL SOLUTIONS MEDICAL GROUP

MEDICARE: VITAL SOLUTIONS 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
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1699906453
Entity Type Code : Organization
Provider Name (Legal Business Name) : VITAL SOLUTIONS MEDICAL GROUP
Provider Business Mailing Address
First Line : PO BOX 15655
Second Line :
City : BEVERLY HILLS
State : CA
Zip : 90209-1655
Country : US
Telephone Number : 310-914-9150
Fax Number : 310-914-9705
Provider Business Practice Location Address
First Line : 6000 SAN VICENTE BLVD FL 2
Second Line :
City : LOS ANGELES
State : CA
Zip : 90036-4404
Country : US
Telephone Number : 310-914-9150
Fax Number : 310-914-9705
Authorized Official
Title or Position : MEDICAL DOCTOR
Name : DR. GLENN MARSHAK
Credential : M.D.
Telephone Number : 310-914-9150
Provider Enumeration Date : 07/28/2009
Last Update Date : 07/28/2009

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Directions to “VITAL SOLUTIONS MEDICAL GROUP ” Practice Location

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