Provider Demographics
NPI:1710913371
Name:MITCHELL S. KARLAN, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MITCHELL S. KARLAN, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:SHERWOOD
Authorized Official - Last Name:KARLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-423-9307
Mailing Address - Street 1:310 N SAN VICENTE BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1810
Mailing Address - Country:US
Mailing Address - Phone:310-423-9307
Mailing Address - Fax:310-423-9399
Practice Address - Street 1:310 N SAN VICENTE BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1810
Practice Address - Country:US
Practice Address - Phone:310-423-9307
Practice Address - Fax:310-423-9399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC17799AMedicare ID - Type Unspecified