Provider Demographics
NPI:1255727541
Name:MIKO ANESTHESIA GROUP
Entity type:Organization
Organization Name:MIKO ANESTHESIA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:OBENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-275-2705
Mailing Address - Street 1:435 N ROXBURY DR STE 205
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5004
Mailing Address - Country:US
Mailing Address - Phone:310-275-2705
Mailing Address - Fax:310-275-2701
Practice Address - Street 1:435 N ROXBURY DR STE 205
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5004
Practice Address - Country:US
Practice Address - Phone:310-275-2705
Practice Address - Fax:310-275-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty