Provider Demographics
NPI:1497797427
Name:TOLWIN, MICHAEL H (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:TOLWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 34841
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-0841
Mailing Address - Country:US
Mailing Address - Phone:310-280-9670
Mailing Address - Fax:310-280-9675
Practice Address - Street 1:5000 OVERLAND AVE STE 108
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4969
Practice Address - Country:US
Practice Address - Phone:310-280-9670
Practice Address - Fax:310-280-9675
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG488162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G488160Medicaid
CA00G488160Medicaid