Basic Information
| Provider Information | |||||||||
| NPI: | 1821188368 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL TOISERKANI, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1821 WILSHIRE BLVD #210 | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904035618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104531324 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1821 WILSHIRE BLVD #210 | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904035618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104531324 | ||||||||
| FaxNumber: | 3104538085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 01/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | TOISERKANI | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3105629509 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A76707 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A767071 | 05 | CA | MEDICAID |