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NPI Code Detail

MEDICARE: CHARLES H. TADLOCK, M.D. LTD

MEDICARE: CHARLES H. TADLOCK, M.D. LTD
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
1332900000XNon-Pharmacy Dispensing Site

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962720078
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARLES H. TADLOCK, M.D. LTD
Provider Business Mailing Address
First Line : 2980 N BEVERLY GLEN CIR
Second Line : SUITE 301
City : LOS ANGELES
State : CA
Zip : 90077-1726
Country : US
Telephone Number : 310-474-9809
Fax Number :
Provider Business Practice Location Address
First Line : 6725 S EASTERN AVE STE 6
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-3949
Country : US
Telephone Number : 702-474-0200
Fax Number :
Authorized Official
Title or Position : OWNER
Name : CHARLES H TADLOCK
Credential : M.D.
Telephone Number : 702-474-0200
Provider Enumeration Date : 05/13/2010
Last Update Date : 03/01/2011

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