Provider Demographics
NPI:1871694398
Name:AXELRODE, STEPHEN G (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:AXELRODE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26585 AGOURA RD STE 330
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1958
Practice Address - Country:US
Practice Address - Phone:818-876-1050
Practice Address - Fax:818-876-1026
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4852207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A48520OtherBLUE SHIELD
CAW20A4852CMedicare ID - Type Unspecified
CAW20A4852EMedicare ID - Type Unspecified
CAW20A4852AMedicare ID - Type Unspecified
A93594Medicare UPIN
CAW20A4852DMedicare ID - Type Unspecified
CAW20A4852BMedicare ID - Type Unspecified