MEDICARE: MITCHELL S. KARLAN, M.D., A PROFESSIONAL CORPORATION

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	2086S0122X	Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1710913371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL S. KARLAN, M.D., A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	310 N SAN VICENTE BLVD
Second Line	:	3RD FLOOR
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-1810
Country	:	US
Telephone Number	:	310-423-9307
Fax Number	:	310-423-9399

Provider Business Practice Location Address
First Line	:	310 N SAN VICENTE BLVD
Second Line	:	3RD FLOOR
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-1810
Country	:	US
Telephone Number	:	310-423-9307
Fax Number	:	310-423-9399

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MITCHELL SHERWOOD KARLAN
Credential	:	M.D.
Telephone Number	:	310-423-9307

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	09/10/2007

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