MEDICARE: DR. PHILLIP FJ TIRMAN 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	2085R0202X	Diagnostic Radiology Physician	A49148	CA
2	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	A49148	CA
3	2085R0202X	Diagnostic Radiology Physician	25MA07179200	NJ

General Provider Information

NPI Number	:	1760469548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP FJ TIRMAN M.D.

Provider Business Mailing Address
First Line	:	5776D LINDERO CANYON RD # 469
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-4088
Country	:	US
Telephone Number	:	424-488-1874
Fax Number	:	310-378-0347

Provider Business Practice Location Address
First Line	:	5776D LINDERO CANYON RD STE 469
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-4088
Country	:	US
Telephone Number	:	310-378-0547
Fax Number	:

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	10/13/2021

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