Provider Demographics
NPI:1871779777
Name:MAHFOUZ M. MICHAEL,M.D.,INC
Entity type:Organization
Organization Name:MAHFOUZ M. MICHAEL,M.D.,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHFOUZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-994-0804
Mailing Address - Street 1:P.O BOX 291040
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-9040
Mailing Address - Country:US
Mailing Address - Phone:818-994-0804
Mailing Address - Fax:818-994-1288
Practice Address - Street 1:5417 PACIFIC BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2532
Practice Address - Country:US
Practice Address - Phone:323-581-0101
Practice Address - Fax:323-589-6552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2009-01-05
Deactivation Date:2008-11-10
Deactivation Code:
Reactivation Date:2009-01-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW7196IMedicare PIN