MEDICARE: BEVERLY HEALTHCARE MEDICAL GROUP INC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1992533731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY HEALTHCARE MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	4620 BEVERLY BLVD # 100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3102
Country	:	US
Telephone Number	:	323-318-2423
Fax Number	:	323-318-2427

Provider Business Practice Location Address
First Line	:	4620 BEVERLY BLVD # 100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3102
Country	:	US
Telephone Number	:	323-318-2423
Fax Number	:	323-318-2427

Authorized Official
Title or Position	:	PRESIDENT/ CEO
Name	:	DR. NAHEED PYAR ALI
Credential	:	MD
Telephone Number	:	323-318-2423

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	07/23/2024

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