Provider Demographics
NPI:1164578977
Name:AUDELL, ROBERT ARMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ARMAN
Last Name:AUDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 TRENTON DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3105
Mailing Address - Country:US
Mailing Address - Phone:310-246-0694
Mailing Address - Fax:310-246-0694
Practice Address - Street 1:700 TRENTON DRIVE
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-246-0694
Practice Address - Fax:310-246-0694
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG047826207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF06974Medicare UPIN
G47826Medicare ID - Type Unspecified
CA6027200001Medicare NSC