Provider Demographics
NPI:1568418002
Name:MILEFCHIK-RAND MEDICAL GROUP
Entity Type:Organization
Organization Name:MILEFCHIK-RAND MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:NILES
Authorized Official - Last Name:MILEFCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-784-4962
Mailing Address - Street 1:2841 LOMITA BLVD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5073
Mailing Address - Country:US
Mailing Address - Phone:310-784-6954
Mailing Address - Fax:310-326-5679
Practice Address - Street 1:2841 LOMITA BLVD
Practice Address - Street 2:SUITE 135
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5073
Practice Address - Country:US
Practice Address - Phone:310-784-6954
Practice Address - Fax:310-326-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67743174400000X
CAA054671174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH05362Medicare UPIN
CAF89513Medicare UPIN
CAF83763Medicare UPIN
CAG57000Medicare UPIN