Provider Demographics
NPI:1124017496
Name:DEAUVILLE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:DEAUVILLE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIGUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-358-9000
Mailing Address - Street 1:7190 W SUNSET BLVD
Mailing Address - Street 2:#243
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4415
Mailing Address - Country:US
Mailing Address - Phone:323-655-6250
Mailing Address - Fax:323-655-1619
Practice Address - Street 1:292 S LA CIENEGA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3393
Practice Address - Country:US
Practice Address - Phone:213-304-3512
Practice Address - Fax:323-525-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG113242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty