Provider Demographics
NPI:1467406660
Name:STEPHEN P SCHALL MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:STEPHEN P SCHALL MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-273-3011
Mailing Address - Street 1:420 E 3RD ST STE 603
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1645
Mailing Address - Country:US
Mailing Address - Phone:213-625-2694
Mailing Address - Fax:213-712-7023
Practice Address - Street 1:9100 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3415
Practice Address - Country:US
Practice Address - Phone:310-273-3011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G397371Medicaid
180011220OtherRAILROAD MEDICARE
00G397370OtherBLUE SHIELD
180011220OtherRAILROAD MEDICARE