MEDICARE: MEN'S HEALTH FOUNDATION 8601

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1831863596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEN'S HEALTH FOUNDATION 8601

Provider Business Mailing Address
First Line	:	8601 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-3319
Country	:	US
Telephone Number	:	323-905-5675
Fax Number	:

Provider Business Practice Location Address
First Line	:	8601 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-3319
Country	:	US
Telephone Number	:	323-905-5675
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANTHONY MARTIN MILLS
Credential	:
Telephone Number	:	310-550-1010

Provider Enumeration Date	:	08/05/2021
Last Update Date	:	08/05/2021

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