Provider Demographics
NPI:1184631251
Name:WESTSIDE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:WESTSIDE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BISCOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-264-0065
Mailing Address - Street 1:2121 WILSHIRE BLVD
Mailing Address - Street 2:# 304
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403
Mailing Address - Country:US
Mailing Address - Phone:310-264-0065
Mailing Address - Fax:310-829-0765
Practice Address - Street 1:2121 WILSHIRE BLVD
Practice Address - Street 2:# 304
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403
Practice Address - Country:US
Practice Address - Phone:310-264-0065
Practice Address - Fax:310-829-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1459Medicare ID - Type Unspecified