Provider Demographics
NPI:1275750721
Name:BABAK A. GILADI, DPM, INC.
Entity Type:Organization
Organization Name:BABAK A. GILADI, DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:GILADI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-704-7057
Mailing Address - Street 1:8549 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1262
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3104
Mailing Address - Country:US
Mailing Address - Phone:310-704-7057
Mailing Address - Fax:310-550-9020
Practice Address - Street 1:18701 SHERMAN WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4045
Practice Address - Country:US
Practice Address - Phone:310-346-4040
Practice Address - Fax:310-550-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4116213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU69646Medicare UPIN
CA5198230003Medicare NSC
CAW16776Medicare ID - Type Unspecified