Provider Demographics
NPI:1013996172
Name:MISCHEL, MATTHEW G (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:MISCHEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5805 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2546
Mailing Address - Country:US
Mailing Address - Phone:818-908-8048
Mailing Address - Fax:818-908-8072
Practice Address - Street 1:15211 VANOWEN ST
Practice Address - Street 2:SUITE 315
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3606
Practice Address - Country:US
Practice Address - Phone:818-787-2410
Practice Address - Fax:818-756-0723
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2008-04-22
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Provider Licenses
StateLicense IDTaxonomies
CAG57538207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G575380Medicaid
CAE93203Medicare UPIN
CAWG57538AMedicare PIN