Provider Demographics
NPI:1871552661
Name:HENDEL, ELI EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:ELI
Middle Name:EDWARD
Last Name:HENDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16271
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91416-6271
Mailing Address - Country:US
Mailing Address - Phone:818-788-6172
Mailing Address - Fax:818-788-4431
Practice Address - Street 1:1500 SOUTH CENTRAL AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204
Practice Address - Country:US
Practice Address - Phone:818-500-9545
Practice Address - Fax:818-500-7414
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36257207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A362570Medicaid
A84868Medicare UPIN
CAA36257Medicare ID - Type Unspecified