Provider Demographics
NPI:1588832182
Name:ILYA GELMAN, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ILYA GELMAN, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-653-2504
Mailing Address - Street 1:6333 WILSHIRE BLVD
Mailing Address - Street 2:STE200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5702
Mailing Address - Country:US
Mailing Address - Phone:323-653-2504
Mailing Address - Fax:323-653-2515
Practice Address - Street 1:6333 WILSHIRE BLVD
Practice Address - Street 2:STE200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5702
Practice Address - Country:US
Practice Address - Phone:323-653-2504
Practice Address - Fax:323-653-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56511207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A565111Medicaid
CAG80638Medicare UPIN