Provider Demographics
NPI:1710991138
Name:LESAVOY, MALCOLM ALAN (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:ALAN
Last Name:LESAVOY
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9301 WILSHIRE BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-6143
Mailing Address - Country:US
Mailing Address - Phone:310-248-5451
Mailing Address - Fax:310-274-3482
Practice Address - Street 1:9301 WILSHIRE BLVD STE 410
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6143
Practice Address - Country:US
Practice Address - Phone:310-248-5451
Practice Address - Fax:310-274-3482
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26213208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G262130OtherMEDICAL PPIN #
CAWG26213HMedicare ID - Type UnspecifiedPPIN #
CAA42941Medicare UPIN