Provider Demographics
NPI:1205095643
Name:ORTHOPAEDIC SURGERY MEDICAL GROUP
Entity type:Organization
Organization Name:ORTHOPAEDIC SURGERY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JERROLD
Authorized Official - Last Name:EINBUND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-684-8844
Mailing Address - Street 1:1125 E 17TH ST
Mailing Address - Street 2:#E218
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2201
Mailing Address - Country:US
Mailing Address - Phone:714-835-3031
Mailing Address - Fax:714-835-6546
Practice Address - Street 1:4156 10TH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3181
Practice Address - Country:US
Practice Address - Phone:951-684-8844
Practice Address - Fax:951-684-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30384207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWC30384Medicare PIN