Provider Demographics
NPI:1477727923
Name:SPINAL CEREBRAL MEDICAL GROUP
Entity Type:Organization
Organization Name:SPINAL CEREBRAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:SUKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-834-1303
Mailing Address - Street 1:999 N TUSTIN AVE STE # 13
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:714-834-1303
Mailing Address - Fax:714-834-1022
Practice Address - Street 1:999 N TUSTIN AVE STE 13
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3530
Practice Address - Country:US
Practice Address - Phone:714-834-1303
Practice Address - Fax:714-834-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G10280Medicare PIN