Provider Demographics
NPI:1598996134
Name:MICHAEL J. MARCUS DPM A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL J. MARCUS DPM A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-724-6663
Mailing Address - Street 1:101 E BEVERLY BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4315
Mailing Address - Country:US
Mailing Address - Phone:323-724-6663
Mailing Address - Fax:323-724-5816
Practice Address - Street 1:16300 SAND CANYON AVENUE
Practice Address - Street 2:SUITE 708
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3707
Practice Address - Country:US
Practice Address - Phone:949-727-3884
Practice Address - Fax:949-753-9115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL J. MARCUS, DPM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-30
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598996134Medicaid
CA1598996134Medicaid
CAT11098Medicare UPIN
CA0513220002Medicare NSC