Provider Demographics
NPI:1528364395
Name:MLS MEDICAL GROUP
Entity Type:Organization
Organization Name:MLS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIHAD
Authorized Official - Middle Name:SHAKER
Authorized Official - Last Name:AL-IMAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-518-6054
Mailing Address - Street 1:14545 FRIAR ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2397
Mailing Address - Country:US
Mailing Address - Phone:818-518-6054
Mailing Address - Fax:818-518-6054
Practice Address - Street 1:14545 FRIAR ST
Practice Address - Street 2:SUITE 109
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2397
Practice Address - Country:US
Practice Address - Phone:818-518-6054
Practice Address - Fax:818-518-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty