MEDICARE: DR. STEPHEN D SHOLKOFF MD

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	C28631	CA

General Provider Information

NPI Number	:	1780618959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN D SHOLKOFF MD

Provider Business Mailing Address
First Line	:	1324 GALAXY DR
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-4919
Country	:	US
Telephone Number	:	949-642-2802
Fax Number	:	949-642-2916

Provider Business Practice Location Address
First Line	:	1324 GALAXY DR
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-4919
Country	:	US
Telephone Number	:	949-642-2802
Fax Number	:	949-642-2916

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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