Provider Demographics
NPI:1508983123
Name:COLIMA INTERNAL MEDICAL GROUP
Entity Type:Organization
Organization Name:COLIMA INTERNAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORTON
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:FUTTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-789-7722
Mailing Address - Street 1:15141 WHITTIER BLVD
Mailing Address - Street 2:#260
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2135
Mailing Address - Country:US
Mailing Address - Phone:562-789-7722
Mailing Address - Fax:562-693-7016
Practice Address - Street 1:15141 WHITTIER BLVD
Practice Address - Street 2:#260
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2135
Practice Address - Country:US
Practice Address - Phone:562-789-7722
Practice Address - Fax:562-693-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA20876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275689184OtherNPI INDIVIDUAL
CA95-25882549OtherTAX ID
CAW1352Medicare PIN