1598996134 NPI number — MICHAEL J. MARCUS DPM A PROFESSIONAL CORPORATION

Table of content: (NPI 1598996134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598996134 NPI number — MICHAEL J. MARCUS DPM A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL J. MARCUS DPM A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598996134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E BEVERLY BLVD STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEBELLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90640-4315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-724-6663
Provider Business Mailing Address Fax Number:
323-724-5816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16300 SAND CANYON AVENUE
Provider Second Line Business Practice Location Address:
SUITE 708
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-727-3884
Provider Business Practice Location Address Fax Number:
949-753-9115
Provider Enumeration Date:
07/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MARCUS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
323-724-6663

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1598996134 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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