Provider Demographics
NPI:1235336033
Name:DAVID J LOURIE MD INC WES J POWELL MD INC DAVID R MARTIN MD INC
Entity Type:Organization
Organization Name:DAVID J LOURIE MD INC WES J POWELL MD INC DAVID R MARTIN MD INC
Other - Org Name:PASADENA LAPAROSCOPIC SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:KISACKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-449-0694
Mailing Address - Street 1:50 BELLEFONTAINE ST STE 404
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3132
Mailing Address - Country:US
Mailing Address - Phone:626-449-0694
Mailing Address - Fax:626-449-4607
Practice Address - Street 1:50 BELLEFONTAINE ST STE 404
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3132
Practice Address - Country:US
Practice Address - Phone:626-449-0694
Practice Address - Fax:626-449-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty