Provider Demographics
NPI:1710228069
Name:MARSHALL L. KADNER, M.D., INC.
Entity Type:Organization
Organization Name:MARSHALL L. KADNER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-432-6640
Mailing Address - Street 1:421 N RODEO DR
Mailing Address - Street 2:PENTHOUSE NUMBER 1
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:421 N RODEO DR
Practice Address - Street 2:PENTHOUSE NUMBER 1
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4500
Practice Address - Country:US
Practice Address - Phone:310-432-6646
Practice Address - Fax:310-432-6647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG5649174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG5649OtherMEDICARE PTAN
CAA57337Medicare UPIN