Provider Demographics
NPI:1265256176
Name:SERGEY SERGEYEVICH PROGUSHEV MD INC
Entity type:Organization
Organization Name:SERGEY SERGEYEVICH PROGUSHEV MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:SERGEYEVICH
Authorized Official - Last Name:PROGUSHEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-658-1150
Mailing Address - Street 1:686 MONTEREY PL
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2105
Mailing Address - Country:US
Mailing Address - Phone:912-658-1150
Mailing Address - Fax:
Practice Address - Street 1:18330 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4105
Practice Address - Country:US
Practice Address - Phone:747-224-4004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty