Provider Demographics
NPI:1417043290
Name:MISALI MED. GR. INC.
Entity Type:Organization
Organization Name:MISALI MED. GR. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:LITWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-441-9945
Mailing Address - Street 1:10430 WILSHIRE BLVD
Mailing Address - Street 2:NO. 206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4651
Mailing Address - Country:US
Mailing Address - Phone:310-441-9945
Mailing Address - Fax:818-782-7026
Practice Address - Street 1:10430 WILSHIRE BLVD
Practice Address - Street 2:NO. 206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4651
Practice Address - Country:US
Practice Address - Phone:310-441-9945
Practice Address - Fax:818-782-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG118562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG11856OtherMEDICAL LIC. NO.
CAG11856OtherMEDICAL LIC. NO.
CAWG11856AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NO.