Provider Demographics
NPI:1033100045
Name:GALLIK, DONNA M (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:GALLIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17176 AVENIDA DE SANTA YNEZ
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2133
Mailing Address - Country:US
Mailing Address - Phone:310-289-5901
Mailing Address - Fax:
Practice Address - Street 1:8361 W 3RD ST
Practice Address - Street 2:SUITE 1017
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4312
Practice Address - Country:US
Practice Address - Phone:310-289-5901
Practice Address - Fax:310-289-5917
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80598207R00000X, 207RC0000X, 207RC0001X
MN65276207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG80598AMedicare PIN