Provider Demographics
NPI:1265757959
Name:LEWIS R. WEINTRAUB,M.D. A MEDICAL CORP.
Entity type:Organization
Organization Name:LEWIS R. WEINTRAUB,M.D. A MEDICAL CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEINTRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-783-7277
Mailing Address - Street 1:5400 BALBOA BLVD
Mailing Address - Street 2:STE 228
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1502
Mailing Address - Country:US
Mailing Address - Phone:818-783-7277
Mailing Address - Fax:818-783-9607
Practice Address - Street 1:5400 BALBOA BLVD
Practice Address - Street 2:STE 228
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1502
Practice Address - Country:US
Practice Address - Phone:818-783-7277
Practice Address - Fax:818-783-9607
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEWIS R. WEINTRAUB, M.D. A MEDICAL CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-06
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG9352208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265757959OtherRAILROAD MEDICARE
CAB58195Medicare UPIN
CAG9352Medicare PIN