Provider Demographics
NPI:1518006014
Name:RICHARD PROTZEL MD, INC.
Entity Type:Organization
Organization Name:RICHARD PROTZEL MD, INC.
Other - Org Name:PROTZEL PATHOLOGY LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATHOLOGIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PROTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-858-0874
Mailing Address - Street 1:9735 WILSHIRE BLVD # 249
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2107
Mailing Address - Country:US
Mailing Address - Phone:310-858-0774
Mailing Address - Fax:310-858-0983
Practice Address - Street 1:9735 WILSHIRE BLVD # 249
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2107
Practice Address - Country:US
Practice Address - Phone:310-858-0774
Practice Address - Fax:310-858-0983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD PROTZEL MD,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-05
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB04134FMedicaid
CAX558316Medicare PIN