Provider Demographics
NPI:1689949018
Name:MICHAEL S. REDER, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL S. REDER, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLEVOTOMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-986-1200
Mailing Address - Street 1:16500 VENTURA BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2011
Mailing Address - Country:US
Mailing Address - Phone:818-986-1200
Mailing Address - Fax:818-986-3011
Practice Address - Street 1:16500 VENTURA BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2011
Practice Address - Country:US
Practice Address - Phone:818-986-1200
Practice Address - Fax:818-986-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34552207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty