Provider Demographics
NPI:1821121328
Name:FELICE L. GERSH, M.D., INC.
Entity Type:Organization
Organization Name:FELICE L. GERSH, M.D., INC.
Other - Org Name:INTEGRATIVE MEDICAL GROUP OF IRVINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GERSH
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:949-753-7475
Mailing Address - Street 1:4968 BOOTH CIR
Mailing Address - Street 2:101
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3360
Mailing Address - Country:US
Mailing Address - Phone:949-753-7475
Mailing Address - Fax:949-753-8797
Practice Address - Street 1:4968 BOOTH CIR
Practice Address - Street 2:101
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3360
Practice Address - Country:US
Practice Address - Phone:949-753-7475
Practice Address - Fax:949-753-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W12081Medicare PIN
A47052Medicare UPIN