Provider Demographics
NPI:1760495741
Name:MUSIKANTH, PHILLIP ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ANDREW
Last Name:MUSIKANTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8033 SUNSET BLVD
Mailing Address - Street 2:1014
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-2401
Mailing Address - Country:US
Mailing Address - Phone:323-954-1073
Mailing Address - Fax:323-954-1081
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:STE 401
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4667
Practice Address - Country:US
Practice Address - Phone:323-954-1073
Practice Address - Fax:323-954-1081
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50223174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A502230Medicaid
CA00A502230Medicaid
CAF60892Medicare UPIN
CAWA50223G, WA50223HMedicare ID - Type Unspecified