Provider Demographics
NPI:1093756413
Name:TOWER INFECTIOUS DISEASES MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:TOWER INFECTIOUS DISEASES MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:ZAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-358-2300
Mailing Address - Street 1:8635 W 3RD ST STE 465W
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6111
Mailing Address - Country:US
Mailing Address - Phone:310-358-2300
Mailing Address - Fax:310-358-2308
Practice Address - Street 1:8635 W 3RD ST STE 465W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6111
Practice Address - Country:US
Practice Address - Phone:310-358-2300
Practice Address - Fax:310-358-2308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13560Medicare PIN