Provider Demographics
NPI:1568476471
Name:SPIRT, MITCHELL J (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:J
Last Name:SPIRT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 ROMA CT
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7271
Mailing Address - Country:US
Mailing Address - Phone:310-551-0082
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK EAST
Practice Address - Street 2:SUITE 1106
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2014
Practice Address - Country:US
Practice Address - Phone:310-551-0082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75156207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F79918Medicare UPIN