Provider Demographics
NPI:1881643856
Name:FOOTE-GOLDMAN-SAPKIN MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:FOOTE-GOLDMAN-SAPKIN MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:SAPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-788-2001
Mailing Address - Street 1:5400 BALBOA BLVD
Mailing Address - Street 2:SUITE 228
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5212
Mailing Address - Country:US
Mailing Address - Phone:818-788-2001
Mailing Address - Fax:818-788-2021
Practice Address - Street 1:5400 BALBOA BLVD
Practice Address - Street 2:SUITE 228
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5212
Practice Address - Country:US
Practice Address - Phone:818-788-2001
Practice Address - Fax:818-788-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW515Medicare ID - Type Unspecified