Provider Demographics
NPI:1568131365
Name:HEALTHCOSMOS MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:HEALTHCOSMOS MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:POLIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, ESQ,
Authorized Official - Phone:626-922-6821
Mailing Address - Street 1:1100 E GREEN ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2513
Mailing Address - Country:US
Mailing Address - Phone:626-922-6821
Mailing Address - Fax:
Practice Address - Street 1:1100 E GREEN ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2513
Practice Address - Country:US
Practice Address - Phone:626-922-6821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service