Provider Demographics
NPI:1811006653
Name:TAMIR, ILAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ILAN
Middle Name:
Last Name:TAMIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 SO BERVERLY DR
Mailing Address - Street 2:SUITE 602
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035
Mailing Address - Country:US
Mailing Address - Phone:310-274-9221
Mailing Address - Fax:310-274-3540
Practice Address - Street 1:1125 SO BERVERLY DR
Practice Address - Street 2:SUITE 602
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035
Practice Address - Country:US
Practice Address - Phone:310-274-9221
Practice Address - Fax:310-274-3540
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26703207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A24927Medicare UPIN
CAA26703Medicare ID - Type Unspecified