Provider Demographics
NPI:1770629412
Name:SYCAMORE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SYCAMORE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CADANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-724-2121
Mailing Address - Street 1:500 ALFRED NOBEL DR STE 150
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1842
Mailing Address - Country:US
Mailing Address - Phone:510-724-2121
Mailing Address - Fax:
Practice Address - Street 1:500 ALFRED NOBEL DR STE 150
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1842
Practice Address - Country:US
Practice Address - Phone:510-724-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ14913ZMedicare ID - Type Unspecified