Provider Demographics
NPI:1225032774
Name:GLEISCHMAN, STEWART HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:HOWARD
Last Name:GLEISCHMAN
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 1:985 S CARMELINA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5807
Mailing Address - Country:US
Mailing Address - Phone:310-657-6993
Mailing Address - Fax:
Practice Address - Street 1:5757 WILSHIRE BLVD.
Practice Address - Street 2:#6
Practice Address - City:LA
Practice Address - State:CA
Practice Address - Zip Code:90036
Practice Address - Country:US
Practice Address - Phone:310-657-6993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42402208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G424020OtherMEDI CAL
CAA48942Medicare UPIN