Provider Demographics
NPI:1558443820
Name:LYLE D. KURTZ, M.D., INC.
Entity Type:Organization
Organization Name:LYLE D. KURTZ, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-855-1551
Mailing Address - Street 1:8920 WILSHIRE BLVD
Mailing Address - Street 2:SUITE #323
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2007
Mailing Address - Country:US
Mailing Address - Phone:310-855-1551
Mailing Address - Fax:310-659-8773
Practice Address - Street 1:8920 WILSHIRE BLVD
Practice Address - Street 2:SUITE #323
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2007
Practice Address - Country:US
Practice Address - Phone:310-855-1551
Practice Address - Fax:310-659-8773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 66758207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF23229Medicare UPIN