Provider Demographics
NPI:1992024186
Name:IVOR A EMANUEL MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:IVOR A EMANUEL MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:EMANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-702-4557
Mailing Address - Street 1:490 POST ST
Mailing Address - Street 2:SUITE 1230
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1401
Mailing Address - Country:US
Mailing Address - Phone:925-790-0764
Mailing Address - Fax:
Practice Address - Street 1:490 POST ST
Practice Address - Street 2:SUITE 1230
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1401
Practice Address - Country:US
Practice Address - Phone:925-790-0764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26652207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24913Medicare UPIN